Trends In Coronary Heart Disease Mortality Research Articles

Cardiovascular mortality trends in Switzerland 1995-2018.

Mortality rates due to coronary heart disease (CHD) and stroke have declined in the last century in high-income countries, including Switzerland. However, these rates have plateaued in several countries. We assessed CHD and stroke mortality trends (1995-2018) in Switzerland. We estimated annual rate changes via JoinPoint regression. Rates decreased steadily in most sex and age groups; however, in those aged 60-74, stroke rates plateaued after 2012 among men and CHD rates plateaued after 2015 among women. Cardiovascular mortality continues to decrease in most of the Swiss population. Prevention efforts should be maintained, especially in individuals aged 60-74.

Coronary heart disease and stroke mortality trends in Brazil 2000-2018.

To analyse the mortality rate trend due to coronary heart disease (CHD) and stroke in the adult population in Brazil. From 2000 to 2018, a time trend study with joinpoint regression was conducted among Brazilian men and women aged 35 years and over. Age-adjusted and age, sex specific CHD and stroke trend rate mortality were measured. Crude mortality rates from CHD decreased in both sexes and in all age groups, except for males over 85 years old with an increase of 1.78%. The most accentuated declining occurred for age range 35 to 44 years for both men (52.1%) and women (53.2%) due to stroke and in men (33%) due to CHD, and among women (32%) aged 65 to 74 years due to CHD. Age-adjusted mortality rates for CHD and stroke decreased in both sexes, in the period from 2000 to 2018. The average annual rate for CHD went from 97.09 during 2000-2008 to 78.75 during 2016-2018, whereas the highest percentage of change was observed during 2008 to 2013 (APC -2.5%; 95% CI). The average annual rate for stroke decreased from 104.96 to 69.93, between 2000-2008 and 2016-2018, and the highest percentage of change occurred during the periods from 2008 to 2013 and 2016 to 2018 (APC 4.7%; 95% CI). The downward trend CHD and stroke mortality rates is continuing. Policy intervention directed to strengthen care provision and improve population diets and lifestyles might explain the continued progress, but there is no room for complacency.

Explaining the decline in coronary heart disease mortality rates in Japan: Contributions of changes in risk factors and evidence-based treatments between 1980 and 2012

BackgroundWe aimed to quantify contributions of changes in risks and uptake of evidence-based treatment to coronary heart disease (CHD) mortality trends in Japan between 1980 and 2012. MethodsWe conducted a modelling study for the general population of Japan aged 35 to 84 years using the validated IMPACT model incorporating data sources like Vital Statistics. The main outcome was difference in the number of observed and expected CHD deaths in 2012. ResultsFrom 1980 to 2012, age-adjusted CHD mortality rates in Japan fell by 61%, resulting in 75,700 fewer CHD deaths in 2012 than if the age and sex-specific mortality rates had remained unchanged. Approximately 56% (95% uncertainty interval [UI]: 54–59%) of the CHD mortality decrease, corresponding to 42,300 (40,900–44,700) fewer CHD deaths, was attributable to medical and surgical treatments. Approximately 35% (28–41%) of the mortality fall corresponding to 26,300 (21,200–31,000) fewer CHD deaths, was attributable to risk factor changes in the population, 24% (20–29%) corresponding to 18,400 (15,100–21,900) fewer and 11% (8–14%) corresponding to 8400 (60,500–10,600) fewer from decreased systolic blood pressure (8.87 mm Hg) and smoking prevalence (14.0%). However, increased levels of cholesterol (0.28 mmol/L), body mass index (BMI) (0.68 kg/m2), and diabetes prevalence (1.6%) attenuated the decrease in mortality by 2% (1–3%), 3% (2–3%), and 4% (1–6%), respectively. ConclusionsJapan should continue their control policies for blood pressure and tobacco, and build a strategy to control BMI, diabetes, and cholesterol levels to prevent further CHD deaths.

Coronary heart disease mortality trends during 50 years as explained by risk factor changes: The European cohorts of the Seven Countries Study.

The purpose of this study was to relate risk factor changes during decades with 50-year coronary heart disease mortality in European cohorts of middle-aged men of the Seven Countries Study. In the 1950s-early 1960s, nine cohorts of 6518 men aged 40-59 years were examined in five European countries. Smoking habits, systolic blood pressure and serum cholesterol were measured at entry and five times during the next 35 years and a comprehensive Risk Factor Change Score was created. Coronary heart disease mortality data was collected during a 50-year follow-up, modelled by the Weibull distribution, whose shape (Weibull shape) was related to the Risk Factor Change Score by linear regression. The Risk Factor Change Score showed slight declines in the Finnish and Dutch cohorts, moderate or large increases in the other cohorts. These effects were related to a decrease of smoking habits in all cohorts, an increase of blood pressure in all cohorts except East Finland, a decrease of serum cholesterol in Finland and the Netherlands, whereas serum cholesterol increases were slight in Italy and large in Serbia and Greece. Weibull distribution shape for coronary heart disease mortality showed slight deceleration in one Finnish and the Dutch cohorts, large acceleration in the Serbian and Greek cohorts. The correlation coefficient of the Risk Factor Change Score versus Weibull shape for the nine cohorts was 0.78 (R2 = 0.60; p = 0.0132). Spontaneous long-term changes of major coronary risk factor levels were associated with changes in the same direction of coronary heart disease mortality risk modelled by the Weibull distribution, expressing a kind of 'natural experiment' with an outcome that matches those of controlled preventive trials.

Moderate to High Levels of Cardiorespiratory Fitness Attenuate the Effects of Triglyceride to High-Density Lipoprotein Cholesterol Ratio on Coronary Heart Disease Mortality in Men

ObjectiveTo examine the prospective relationships among cardiorespiratory fitness (CRF), fasting blood triglyceride to high density lipoprotein cholesterol ratio (TG:HDL-C), and coronary heart disease (CHD) mortality in men. MethodsA total of 40,269 men received a comprehensive baseline clinical examination between January 1, 1978, and December 31, 2010. Their CRF was determined from a maximal treadmill exercise test. Participants were divided into CRF categories of low, moderate, and high fit by age group and by TG:HDL-C quartiles. Hazard ratios for CHD mortality were computed using Cox regression analysis. ResultsA total of 556 deaths due to CHD occurred during a mean ± SD of 16.6±9.7 years (669,678 man-years) of follow-up. A significant positive trend in adjusted CHD mortality was shown across decreasing CRF categories (P for trend<.01). Adjusted hazard ratios were significantly higher across increasing TG:HDL-C quartiles as well (P for trend<.01). When grouped by CRF category and TG:HDL-C quartile, there was a significant positive trend (P=.04) in CHD mortality across decreasing CRF categories in each TG:HDL-C quartile. ConclusionBoth CRF and TG:HDL-C are significantly associated with CHD mortality in men. The risk of CHD mortality in each TG:HDL-C quartile was significantly attenuated in men with moderate to high CRF compared with men with low CRF. These results suggest that assessment of CRF and TG:HDL-C should be included for routine CHD mortality risk assessment and risk management.

Abstract P115: Better Methodologies to Compare Coronary Heart Disease Mortality Trends in Latin American Countries: Argentina, Colombia and Mexico From 1985 to 2012

Introduction: Coronary heart disease (CHD) is the leading cause of death worldwide. CHD mortality rates have decreased in most high-income countries, but increased in some Latin-American countries. CHD mortality rates have plateaued among young adults (&lt;55 years) in the US, UK and Australia, but trends in Latin-America are largely unknown. Few studies have analyzed trends in age and sex-specific CHD mortality rates in this region, and almost none has assured data quality by correcting for garbage codes (ICD codes for nonspecific causes of death) as recommended by WHO. Objective: To describe and compare standardized, age-specific and garbage-code corrected mortality trends for coronary heart disease (CHD) from 1985 to 2012 in three contrasting Latin American countries. Methods: CHD deaths (1985-2012) in Argentina, Colombia and Mexico were grouped by calendar year, sex and 10-year age bands to calculate the overall age-adjusted and age and sex specific mortality rates for adults aged ≥25 years. We corrected for garbage-codes for the three countries (1997-2012) using the Global Burden of Disease (GBD) methodology. We then fitted Joinpoint regression models, using the original and garbage code corrected rates, to estimate the annual percent change (APC) and detect points in time when significant changes in the trends occurred. Results: In 2012, age-standardised mortality rates per 100,000 were 65.3 in Argentina, 132.4 in Colombia and 130.3 in Mexico. Compared to 1985, by 2012 mortality fell by 17.5% in Colombia and 52.5% in Argentina. The largest annual decreases in mortality rates were observed in Argentina from 1988-1994 (APC=-5.7 p-value&lt;0.01). The declines in Colombia were constant and smaller for the full period (APC=-0.4 p-value&lt;0.01). CHD mortality rose by 48.9% in Mexico, particularly after 2000. Mortality rates increased in both men and women, particularly in younger men (&lt;39 years) and older women (&gt;60 years). Application of the garbage code corrections produced dramatic increases in mortality rates, more in women than men, and particularly in Argentina: approximately 80 additional deaths per 100,000 (compared with just 14 additional deaths per 10 5 in Colombia and 13 per 10 5 in Mexico). Conclusions: Different Latin American countries demonstrate dramatically different CHD epidemiology. Mortality rates increased after correcting for garbage code misclassification. Although CHD mortality is falling in Argentina, the modest falls in Colombia and substantial rises in Mexico highlight the region’s urgent need for effective, population-wide prevention policies.

Comparison of Trends in Mortality from Coronary Heart and Cerebrovascular Diseases in North and South America: 1980 to 2013

Until the past century, mortality trends from coronary heart disease (CHD) and cerebrovascular disease (CVD) were less favorable in Latin than in North America. We calculated age-standardized mortality rates using data from the World Health Organization database over the period 1980 to 2013. To identify significant changes in trends, we performed joinpoint analysis. Since the early 2000's, CHD mortality rates decreased by about 35% in the USA and Canada in both genders; similar decreases were observed in some Latin American countries (i.e., Ecuador, Puerto Rico, and Chile), whereas the decreases were smaller in the other countries. In 2011 to 2013, the highest rates were in Venezuela (114.4/100,000 men) and Colombia (86.1/100,000 men) and the lowest ones (apart from Ecuador) in Panama, Chile, and Argentina (from 41 to 46/100,000 men and 18 to 19/100,000 women). For CVD mortality, a decrease by about 30% was observed in Argentina, Panama, and Uruguay plus Colombia for women, in addition to the USA and Canada. Smaller declines were observed in the other Latin American countries (from 23% in Colombian men to 5% in Venezuelan men). Throughout the period, rates in Latin America remained appreciably higher than those in North America. The highest CVD rates were observed in Brazil (51.6/100,000 men) and the lowest ones in Canada (12.9/100,000 women). In conclusion, trends in CHD and CVD mortality continue to be less favorable in Latin America than in Canada and the USA. The marked excess of CVD mortality is partly or largely attributable to inadequate control of dyslipidemia and hypertension.

Regional variation in coronary heart disease mortality trends in Portugal, 1981–2012

BackgroundInformation is scarce about the geographic variation in time trends of mortality from coronary heart disease (CHD). We aimed to describe trends in death rates, absolute number of deaths and years of life lost (YLL) due to CHD among men and women in Portugal, by region, from 1981 to 2012. MethodsThe age-standardized mortality rates from CHD were estimated by sex and region. We used joinpoint regression analysis to calculate the annual percent change (APC) in mortality and to identify points of significant change in the trend. The YLL due to premature mortality for CHD were computed using the Global Burden of Disease method. ResultsThe age-adjusted mortality from CHD decreased between 1981 and 2012, both in men and women, but with significantly different APC by region. Smaller declines in rates were observed in Alentejo (men: APC 1993–2012: −2.4%; women: APC 1991–2012: −2.4%). The greatest decline was observed in Madeira between 2003 and 2012, in men (APC: −7.6%) and women (APC: −9.7%). The decline in rates in Algarve started only after 2003, whereas it was consistent from 1981 in the North and started in the 1990s in most other regions. A decrease in the number of deaths was only observed after 2000. The YLL from CHD decreased from 1981 to 2012, mainly after 2000. ConclusionsIn Portugal, between 1981 and 2012, relative declines of CHD mortality indicators were different by geographic region. Consistent decreases in mortality rates were only observed in the Centre, Lisbon and North, the most populated and urbanized regions.

Potential benefits of healthy food and lifestyle policies for reducing coronary heart disease mortality in Turkish adults by 2025: a modelling study

ObjectiveThis study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intake, mean body mass...

40-Year CHD Mortality Trends and the Role ofRisk Factors in Mortality Decline: The North Karelia Project Experience.

In the 1960s and early 1970s, coronary heart disease (CHD) mortality in Finland was the highest in the world, and within Finland, mortality was particularly high in the eastern part of the country. The North Karelia Project, the first large community-based cardiovascular diseases prevention program was established in 1972 to reduce the extremely high CHD mortality through behavioral change and reduction of the main cardiovascular disease risk factors among the whole population of North Karelia, the easternmost province of Finland. During the 40-year period from 1972 to 2012, smoking prevalence, serum total cholesterol, and systolic blood pressure declined markedly, except a small increase in serum cholesterol levels between 2007 and 2012. From the early 1970s to 2012, CHD mortality decreased by 82% (from 643 to 118 per 100,000) among working-age (35 to 64 years) men. Among working-age women, the decline was 84% (from 114 to 17 per 100,000). During the first 10 years, changes in these 3 target risk factors explained nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than the predicted reduction. In the early 1970s, premature CHD mortality (35 to 74 years) was about 37% higher among Eastern Finnish men and 23% higher among Eastern Finnish women, compared with men and women in Southwestern Finland. During the last 40 years, premature CHD mortality declined markedly in both areas, but the decline was larger in Eastern Finland and the mortality gap between the two areas nearly disappeared.

OP76 Saturated fat intake and future chd mortality in sweden. a modelling study

Background Since mid-1980s, coronary heart disease (CHD) mortality rates in Sweden have more than halved, largely reflecting improvements in cardiovascular risk factors, mainly improvements in total cholesterol. However, this favourable trend in total cholesterol has recently levelled off or even increased in some ages, associated to changes in diet that is richer in saturated fats (SFs) and low in carbohydrates. The purpose of the present study was to project future CHD mortality in Sweden taking into account future trends in dietary SFs intake. Methods The previously validated IMPACT model was used to predict changes in CHD mortality between 2010 and 2025 in the Swedish population aged 25–84. Calculations were based on a) Population numbers and projections (the Swedish National Board of Health and Welfare) b) Population risk factors levels and projections c) effects of risk factor reductions (published meta-analyses and case-control studies). We assumed that the observed historical trend in CHD mortality were to continue and compared three different scenarios for future SFs intake, with and without favourable changes in other major risk factors: - S1: Reduction in daily intake of SFs in Sweden to 10% total energy (E) assuming substitution with unsaturated fats; - S2: Continuing current trends in SFs intake; - S3: Increasing intake of SF (20% E, consistent with fat-rich, low carb diet) 95% CI were obtained using a probabilistic sensitivity analysis Results If current CHD mortality trend would continue, 5,975 deaths would be observed in 2025. For S1 scenario 810 (664–955) fewer deaths would occur, resulting in 13.6% (11.9–15.0) mortality reduction. According to S2 scenario, no change in CHD mortality is expected. However if we assume no concurrent favourable changes in other risk factors, expected number of CHD deaths for S2 would be 382 (293–485), about 6.4% (5.1–7.8) increase. For S3 number expected increase in deaths would be 21 (–59–115), but if other risk factors would remain constant this number rises to 401 (334–475), which is equivalent to 6.7% (95% CI: 6.0–7.5) CHD mortality increase. Conclusion CHD mortality can increase as a result of unfavourable trends in diets rich in SFs resulting in cholesterol increases. While favourable trends in other risk factors might reduce its impact, substituting “bad” SFS (from dairy products and meat), with “good” mono-unsaturated (such as olive oil) and poly-unsaturated fats (such as sunflower and canola) is eminently feasible. These small and achievable beneficial dietary changes would have a large effect on CHD mortality.

Trends in coronary heart disease mortality and statin utilization in two European areas with different population risk levels: Stockholm and Sicily

Background and Aim: The reduction in coronary heart disease (CHD) mortality in Europe has been associated with a&lt;br /&gt;reduction in coronary risk factors, including dyslipidaemia. Statins reduce blood cholesterol levels and the risk of coronary&lt;br /&gt;events. Their utilization has substantially increased over the years. Although statins should be prescribed according to clinical&lt;br /&gt;guidelines, doctors’ decisions about treatment are usually made subjectively and are influenced by the population risk level.&lt;br /&gt;The aim of this study was to investigate the relation between the time trend of population risk level and statin utilization in two&lt;br /&gt;areas with different levels of coronary risk in the population.&lt;br /&gt;Methods: CHD mortality, as a proxy of population coronary risk level, and statin utilization trends in the period 2001-2011,&lt;br /&gt;were compared between a relatively high-risk CHD area, Stockholm county, and a low-risk area, Sicily.&lt;br /&gt;Results: There was a reduction in CHD mortality and an increase in statin utilization in both areas. The mean annual reduction&lt;br /&gt;in CHD mortality rate/100,000 was greater in Stockholm than in Sicily (-4.6, 95% CI -5.3 -4.0, and -1.9 95% CI -2.6 – 1.2,&lt;br /&gt;respectively). The mean annual increase in statin DDD/TID utilization was larger in Sicily than in Stockholm (5.1, 95% CI 4.8 –&lt;br /&gt;5.3, and 3.7, 95% CI 3.2 – 4.1, respectively). In Stockholm the increase in statin use was mainly due to increased utilization of&lt;br /&gt;simvastatin, whereas it included a greater variety of statins in Sicily.&lt;br /&gt;Conclusion: The relations between time trends of CHD mortality and statin utilization in Stockholm and in Sicily were&lt;br /&gt;different. A larger increase in statins was observed in the low-risk area, associated with a slower reduction in CHD mortality,&lt;br /&gt;whereas a smaller increase in statins was observed in the high-risk area, associated with a greater reduction in CHD mortality.&lt;br /&gt;Other factors apart from the actual risk of the patients may explain these observations, such as differences in socioeconomic&lt;br /&gt;factors, adherence to treatment, policies of drug cost-containment, and population CHD risk profiles.

Abstract P052: Coronary Heart Disease Mortality Declines in the United States From 1980 through 2011: Evidence for Stagnation in Young Adults, Especially Women

Background: Cardiovascular mortality rates have fallen dramatically over the past four decades. However, recent unfavorable trends in coronary heart disease (CHD) risk factors among young adults (obesity, diabetes, and tobacco use) raise concerns about their subsequent impact on CHD mortality. Furthermore, recent data from the US and other countries suggest a worsening of CHD incidence and mortality among young women. We therefore examined recent trends in CHD mortality rates in the US according to age and sex. Methods: We used mortality data between 1980 and 2011 from US adults ≥ 25 years. We calculated age-specific CHD mortality rates and estimated annual percentage change (EAPC) for US adults, and compared three decades of data (1980-1989, 1990-1999, and 2000-2011). We also used Joinpoint regression modeling to assess changes in trends over time, based on inflection points of the mortality distribution. Results: Young men and women (aged&lt;55 years) showed a robust decline in CHD mortality from 1980 until 1989 (EAPC -5.5% in men and -4.6% in women). However, the two subsequent decades saw stagnation with minimal improvement (Table). This was particularly true for young women who had no improvements between 1990 and 1999 (EAPC +0.1%), and only -1% EAPC since 2000. In contrast, older adults (65+years) showed steep annual declines since 2000, approximately doubled compared with the previous period (women, -5.0% and men, -4.4%). Jointpoint analyses provided consistent results. Conclusions: The dramatic declines in cardiovascular mortality since 1980 conceals major heterogeneities. CHD death rates in older groups are now falling steeply. However, young men and women have enjoyed small decreases in CHD mortality rates since 1990. The drivers of these major differences in CHD mortality trends by age and sex needs urgent study.

OP53 Contrasting cardiovascular mortality trends in Eastern Mediterranean populations – contributions from risk factor changes and treatments: modelling study

Background Middle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a previously validated CHD mortality model (IMPACT) to examine recent trends in CHD mortality in Tunisia, Syria, the occupied Palestinian territory (oPt – West Bank) and Turkey. Methods Data on populations, mortality, patient groups and numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points. Populations of studied countries and timeframes for this analysis were: Tunisia (10 million, 1997–2009), Syria (19 million, 1996–2006), OPt (2.5 million, 1998–2009) and Turkey (73 million, 1995–2008). We integrated and analysed data using the IMPACT model, with uncertainty explored using probabilistic sensitivity analyses. We reported the percentage of the observed change in CHD deaths explained by changes in uptake of medical and surgical treatments and major CHD risk factors for each country. Results Risk factor trends: Regional smoking prevalences were high in men, persisting in Syria but decreasing in Tunisia (-11%), oPt (-25%) and Turkey (-45%). Obesity (body mass index) rose by 1–2kg/m 2 and diabetes prevalence increased by 40%–50% in all four countries. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria but decreased in oPt and stayed constant in Turkey. Mortality trends: Age adjusted CHD mortality rates rose by 30% in Tunisia (49/10 5 to 64/10 5 ) and by 56% in Syria (108/10 5 to 169/10 5 ). Much of this increase (98% in Tunisia, and 80% in Syria) was attributable to adverse trends in major risk factors, and occurred despite some improvements in treatment uptake. CHD mortality rates fell by 25% in oPt (85/10 5 to 64/10 5 ) and by 17% in Turkey (418/10 5 to 345/10 5 ), with risk factor changes accounting for around 65% and 60% of this reduction respectively. Increased uptake of community treatments accounted for the remainder. The IMPACT model explained approximately 77% of the observed mortality trends in Turkey and oPt, but less in Syria and Tunisia. Results remained fairly consistent following sensitivity analyses. Conclusion Eastern Mediterranean countries have shown highly heterogeneous trends in blood pressure, blood cholesterol and CHD mortality. Death rates are rising in Tunisia and Syria, whilst Turkey and occupied Palestinian territories demonstrate clear mortality falls, reflecting improvements in major cardiovascular risk factors, plus contributions from community-based medical treatments. However, across the region, smoking prevalence remains very high in men, and obesity and diabetes levels are rising dramatically. Powerful prevention policies exist and should now be implemented.

OP69 Predicting future trends and inequalities in premature coronary heart disease deaths in England: modelling study

Background Coronary heart disease (CHD) deaths in the UK have plummeted since the 1970s. However, CHD remains the biggest single cause of premature mortality, particularly in deprived social groups. But have all social groups benefited equally from these declines? Or do the headline figures conceal differences in rates of decline among social strata, potentially generating conflicting views on inequalities? Our analysis therefore aimed to examine whether the rapid declines in overall CHD mortality have benefited all socio-economic groups, and explore the implications for future projections. Methods We used a Bayesian analysis of an age-period-cohort model for the English population with data from Office for National Statistics (ONS). We projected age-specific CHD mortality by gender and deprivation status for the period 2007–2035, using 1982–2006 as the input. We converted the age-specific values to premature CHD death rates (ages 35–74). Deprivation status was measured by Index of Multiple Deprivation quintiles, which aggregate seven types of deprivation, including health and income. We first analysed the influence of the population-level trend in premature CHD mortality on absolute inequality, and second investigated the contributions to change in relative inequality. We quantified inequality by the variance in the probability of premature death among deprivation quintiles. Furthermore, we introduced a method to analyse the contribution of each group to the change in variance over time. Results We found that overall mortality trends conceal heterogeneities. Our models predict more rapid declines in premature CHD death for the most affluent than for the most deprived quintiles (annualised rate of decline 2006–2025, 7.9% [95% CI 4.7–11.0% ] versus 6.0% [ 1.9–10.0% ] for men, and 6.3% [ 3.5–9.0% ] versus 5.9% [ 2.2–9.5% ] for women). Absolute inequality was projected to decrease by 87% ( 29–98% ) among men and by 89% ( 48–98% ) among women. This decrease was particularly driven by the most deprived groups, reflecting their higher premature death rates. However, relative inequality was projected to rise by 60% among men ( 26–107% ) and by 10% ( -15–42% ) among women. Because premature death is declining more slowly in the most deprived, these increases are also mostly influenced by the most deprived. Conclusion Overall, premature coronary death rates in England continue to decline steeply, regardless of deprivation status. Furthermore, absolute inequalities are decreasing, reflecting declines in the high premature mortality burden in deprived groups. However, relative inequalities are projected to widen further, reflecting slower mortality declines in the most deprived groups. We suggest that more aggressive and progressive prevention policies are urgently needed.

Abstract P364: Recent Trends In Mortality From Coronary Heart Disease Mortality And Its Risk Factors In Selected Developed Countries

Objectives: Mortality from coronary heart disease (CHD) in developed countries started to decline in the late 1960’s and early 1970’s and age-adjusted CHD mortality fell about 50%. This decline is attributed to favorable changes in risk factors in the general population, i.e., total cholesterol, blood pressure, smoking, etc., and improved treatment of CHD. We examined recent trends in CHD mortality and its risk factors in selected developed countries. Methods: We selected Australia, Canada, France, Italy, Japan, Spain, Sweden, the UK, and the US. Data on CHD mortality between 1980 and 2005-08 were obtained from the WHO Statistical Information System. To define CHD mortality, codes I20-25 in ICD-10 and corresponding codes in ICDs 8 and 9 were used. Data on risk factors, primarily total cholesterol and systolic blood pressure during the same period were obtained from national surveys as well as literature. Results: in 1980, there was a 2 to 3-fold difference in age-adjusted CHD mortality among these countries both in men and women, with the UK, the US and Canada being high and Japan and France being low. Although between 1980 and 2005-08, age-adjusted CHD mortality continuously declined in all these countries, a 2 to 3-fold difference in the mortality remained with the similar order among these countries. Between 1980 and 2008, age-adjusted mean levels of total cholesterol fell by 21 to 31 mg/dl in men and by 8 to 31 mg/dl in women in these countries except for Japan. Age-adjusted levels of total cholesterol in Japan have continuously increased by 16 mg/dl for both men and women during this period. Meanwhile, between 1980 and 2008 age-adjusted levels of systolic blood pressure fell by 5 to 8 mmHg in men and 6 to 13 mmHg in women in these countries without exception. In 1980, the rate of cigarette smoking in men in Japan was the highest among these countries. Although the rate of smoking in men fell in all these countries, the rates remained the higher in Japan. Conclusions: Age [[Unable to Display Character: &amp;#8211;]]adjusted CHD mortality has continuously declined between 1980 and 2005-08 in these developed countries. The decline was accompanied by a constant decrease in population-levels of total cholesterol by 20 to 30 mg/dl except for Japan where levels of total cholesterol have increased by 16 mg/dl. The reasons for persistently low CHD mortality and its downward trend in Japan are unexplained by traditional risk factors. Identifying preventive factors that determine low CHD rates in the Japanese and implementing such factors to the US would eliminate most of CHD epidemics in the US.

Abstract P365: Turning in the Mortality Trends from Coronary Heart Disease in Japan: Age-Specific Analysis of the Regional Difference in Japan from 1969 to 2007

Objective: To examine the recent mortality trends of coronary heart disease (CHD), we compared the age specific CHD mortality trends in Japan and in urban and in the rest of Japan, respectively using Vital Statistics. Methods and Results: We compared CHD mortality rates in all Japan, the urban population (20 million) and in the rest of Japan (100 million) from 1969 to 2007 for 30 to 69 years of age. In 1969 [[Unable to Display Character: &amp;#8209;]] 1970, the age[[Unable to Display Character: &amp;#8209;]]adjusted CHD mortality rate was 57.7 per 100,000 for men and 25.9 for women in Japan, and was the same as those of the urban population (59.2 for men and 26.8 for women) and the rest of Japan (57.3 for men and 25.9 for women). The CHD mortality rate in the rest of Japan decreased to 28.4 for men and 7.6 for women in 2006-2007. Although CHD mortality rate in the urban population also decreased to 39.9 for men and 10.1 for women in 2006 - 2007, the decline was much smaller. Trends in age-specific CHD mortality rates was compared between Period I (1969 - 1978), Period II (1981- 1994) and period III (1996 - 2007). Among men in Japan and in the rest of Japan, the decline in the mortality rate for the 30 to 49[[Unable to Display Character: &amp;#8209;]]year[[Unable to Display Character: &amp;#8209;]]old[[Unable to Display Character: &amp;#8209;]]age group was initially observed in Period I and II, and has turned to increase significantly (p&lt;0.001) in the Period III while continuous declining trends in 50-59 and 60-69 year old-age-group. Trends in urban population went ahead, changes in the declining trends was observed both the Period II and III among 30-49 year-old-age group and period III among 50-59 year-old-age group while continuous decline was observed among 60-69 year-old-age group. Similar trends were observed among women. These trends coincide with the increase in the fat intake mainly among younger generation. Conclusions: Observed increase in CHD mortality of men in Japan among younger generation proceeded by those in the urban population may predict the future increase in CHD mortality in Japan.

Continuing decrease in coronary heart disease mortality in Sweden

BackgroundDeaths from coronary heart disease (CHD) have been decreasing in most Western countries over the last few decades. In contrast, a flattening of the decrease in mortality has been recently reported among younger age groups in some countries. We aimed to determine whether the decrease in CHD mortality is flattening among Swedish young adults.MethodsWe examined trends in CHD mortality in Sweden between 1987 and 2009 among persons aged 35 to 84 years using CHD mortality data from the Swedish National Register on Cause of Death. Annual percent changes in rates were examined using Joinpoint software.ResultsOverall, CHD mortality rates decreased by 67.4% in men and 65.1% in women. Among men aged 35–54 years, there was a modest early attenuation from a marked initial decrease. In the oldest women aged 75–84 years, an attenuation in the mortality decrease was observed from 1989 to 1992, followed by a decrease, as in all other age groups.ConclusionsIn Sweden, coronary heart disease deaths are still falling. We were unable to confirm a flattening of the decline in young people. Death rates continue to decline in men and women across all age groups, albeit at a slower pace in younger men since 1991. Continued careful monitoring of CHD mortality trends in Sweden is required, particularly among young adults.

Coronary heart disease differences across Europe

In the Seven Countries Study of Cardiovascular Diseases, 16 cohorts of middle-aged men were enrolled in eight nations of seven countries in three continents in the late 1950s and early 1960s for a total of 12 763 individuals. Thirteen cohorts were located in Europe, two in Finland, one in the Netherlands, three in Italy, two in Croatia - former Yugoslavia, three in Serbia - former Yugoslavia, and two in Greece. Another cohort was enrolled in the USA and two cohorts in Japan. Baseline prevalence of coronary heart disease (CHD) was largely different across areas, as well as 10-year incidence of major CHD events and CHD mortality for periods ranging from 25 to 40 years of follow-up. Higher rates were found in Northern Europe, lower rates in Southern Europe and intermediate rates in Eastern Europe, represented by Serbia. Differences across countries were partly explained by different entry mean levels of serum cholesterol, blood pressure, consumption of saturated fatty acids and adherence to traditional dietary patterns. Forty-year trends of CHD mortality were largely explained by early changes in serum cholesterol and blood pressure levels, with large risk increases in Serbia and Greece, and the tendency to declines in Finland and the Netherlands. These trends in Seven Countries' experience are in line with those manifests in official mortality data. An attempt of interpretation is presented pointing to socio-economic evolution in the involved countries, which heavily modifies health and dietary habits and contributes to explaining these differences at population level.

OP53 Explaining Scottish Coronary Heart Disease Mortality Trends between 2000 and 2010: Socioeconomic Analyses using the Impact Sec Model

BackgroundCoronary heart disease (CHD) mortality rates have halved in recent decades. However, CHD remains the largest cause of death in Scotland generating persistent socioeconomic inequalities. A socioeconomic quantification of the...