The prevalence of congenital heart disease (CHD) has increased strikingly in adults and children in a new population study, researchers reported in Circulation: Journal of the American Heart Association.
Severe CHD has risen in adults by 85 percent and 22 percent in children during the 15-year study (1985-2000). Congenital heart defects are structural problems arising from abnormal formation of the heart or major blood vessels near the heart that occurs before birth. Most heart defects either obstruct blood flow in the heart or vessels near it, or cause blood to flow through the heart in an abnormal way.
"This is the first study to measure the changing number of patients in a North American population during a period of major progress in the management of CHD," said Ariane J. Marelli, M.D., lead author of the study and director of the McGill Adult Unit for Congenital Heart Disease Excellence at McGill University in Montreal, Quebec, Canada.
The study measured prevalence, age and proportion of adults relative to children at four time points: 1985, 1990, 1995 and 2000, and analyzed the Quebec administrative databases recorded for the general population where access to health care is universal. Quebec accounts for 25 percent of Canada's population.
"This is the largest population study of CHD to have been performed in North America," Marelli said. "There is no reason to believe that the predominantly Caucasian population of Quebec and Canada is different from the United States."
Extrapolating the study findings to the U.S. population, Marelli estimated 1.8 million Americans had CHD in 2000 and that this number is increasing and will have implications for women, pregnancy and genetics. She estimated about 900,000 adults and 900,000 children had CHD.
In 2000, the study indicated that one of every 85 children had CHD and one of 250 adults had CHD.
"For comparison purposes, cystic fibrosis occurs in one of 4,500 live births, so there are 45 times more children with CHD than children with cystic fibrosis and most of these children are now becoming adults," Marelli said.
Furthermore, more adults have had CHD than children since 1985, and a preponderance are women, the study found.
"Between 1985 and 2000, the group of patients that rose the most rapidly were adults with severe CHD, so, as of 2000, there was a nearly equal number of children and adults with severe CHD," Marelli said
The most significant increases in CHD were in adolescents (13 to 17 years old) and in young adults (18 to 25), according to the study. The median age of those with severe CHD increased markedly from 1985 to 2000. The median age in 1985 was 11 years compared to 17 years in 2000.
"CHD has been thought of as a disease of childhood, but it has become an important disease of adulthood as well," Marelli said. Researchers said the significant new data in the study reflects advances in the diagnosis and surgical treatment of CHD.
"Since the mid-1980s, the advent of cardiac ultrasound has improved the diagnosis of CHD," Marelli said. "This technique can be used to detect CHD beyond the first year of life. Advances in corrective pediatric cardiac surgery have made an impact, enabling children with CHD to live longer." Marelli considers CHD a major public health problem in North America that is largely under-recognized.
"The increasing prevalence of CHD means these children will live longer and acquire other forms of heart disease," Marelli said. "We need to increase public awareness for congenital heart disease in order to be able to better care for the increasing number of young people with heart disease."
The study was funded by the Heart and Stroke Foundation of Canada, the Fonds de la Recherche en Santé du Québec and the Canadian Institutes of Health Research.
Co-authors are Andrew S. Mackie, M.D., S.M.; Raluca Ionescu-Ittu, M.Sc.; Elham Rahme, Ph.D.; and Louise Pilote, M.D., M.P.H., Ph.D.
Statements and conclusions of study authors published in the American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.
NR07 – 1102 (Circ/Marelli)