Spectacular Changes in Heart Disease Death Rates across the Globe

• International comparison shows striking increase and decrease in deaths from heart disease (also called coronary artery disease or CAD).  Between 1990 and 2000, deaths from heart disease decreased by 40% to 50% in Australia, New Zealand, UK, Ireland, Finland, and Norway and by 20% to 30% in  Luxemburg, Italy, Germany, France, Portugal and 20% in the USA. Deaths from heart disease  increased  by 65% in Ukraine, 40%-50% in Kazakhstan, and Belarus, 30% in Russian Federation, and 10% in Japan.¹ Table 132 A. National data is not available for India but official estimates suggest a 5-6% increase in CAD-mortality per year.²

 

 

• The largest proportion of the reduction (more than half) in CAD burden is attributed to improvements in modifiable lifestyle and dietary risk factors.^{3 4} Evidence-based use of medications and interventions accounted for less than half (25% to 55%) of the decrease in CAD mortality worldwide.³  However, the relative contributions of the importance of risk factor modifications versus treatment vary by the country and the period studied.

• In the US, approximately 50% of the decline in CAD death has been attributed to reducing major risk factors and the other half to treatment of CAD including secondary preventive therapies.⁵

• From a population perspective, a reduction in cholesterol by 40 mg/dl is associated with a 40% reduction in CAD mortality and is best achieved through a reduction in the energy intake from saturated fat and not total fat.⁶

Current International Heart Disease Rates

• Although most of the risk factors for heart disease and stroke are the same, the rates of these diseases vary 20-fold among people of different ethnicities around the world and 2-3 fold even within a given country, such as the United States. The highest heart disease death is reported from the Russian Federation (706/100,000 men and 237 in women) and lowest in rural Chinese men (42) and French women (13) compared to US in the middle with 153 in men and 69 in women. Table 133A.

• The highest stroke death is also reported from the Russian Federation 351/100,000 in men and 189 in women and lowest in Switzerland  men (17) and women (12) compared to US in the middle with 24 in men and 24 in women.⁷

• Heart disease is no longer considered a disease of the rich and the burden is much higher in the low-income and middle-income countries.

 

 Sources

1. www.heartstats.org. CHD Statistics. Mortality. 2011. Accessed July 15, 2011.

2. Indrayan A. Forecasting vascular disease cases and associated mortality in India. 2010;http://www.whoindia.org/LinkFiles Sept 25,  2010.

3. Capewell S, O’Flaherty M. What explains declining coronary mortality? Lessons and warnings. Heart. Sep 2008;94(9):1105-1108.

4. Rodriguez T, Malvezzi M, Chatenoud L, et al. Trends in mortality from coronary heart and cerebrovascular diseases in the Americas: 1970-2000. Heart. Apr 2006;92(4):453-460.

5. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. Jun 7 2007;356(23):2388-2398.

6. Lewington S, Whitlock G, Clarke R, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet. Dec 1 2007;370(9602):1829-1839.

7.  American Heart Association. Heart and Stroke Statistical Update2011.