Decline In Ischaemic Heart Disease Mortality Research Articles

Dramatic decline of ischaemic heart disease mortality in post communist central Europe: recovery from totality.

After 1970 the preexisting gap in population health between democratic Europe and communist countries became even more prominent. While in the democratic Europe there was a progressive rise in life expectancy associated with the decline in ischaemic heart disease (IHD), the trend on the other side of the iron curtain was exactly reverse. After the fall of communism in 1989 population health in the post-communist central Europe (CE) rapidly signalled a favourable recovery. This biphasic trend in post-communist countries is very remarkable. Most remarkably the decline in IHD mortality started soon after the demise of totality, even before the modernization of health care (new more effective medications and diagnostic technology), public campaign against smoking and improved supply of protective nutrients got chance to attain an important role. The decades-long psychosocial depression of communism was rapidly replaced with a promise of a better future. It is generally accepted that psychosocial factors are powerfool tools in the pathogenesis of IHD.

Trends in socioeconomic inequalities in mortality from ischaemic heart disease and stroke in Australia, 1979–2006

This study investigates secular trends in ischaemic heart disease (IHD) and stroke mortality by socioeconomic status (SES) in Australia to determine if absolute and relative differences between low and high SES areas have changed over time. IHD and stroke mortality data for adults aged 35-74 years and corresponding population data from Australian censuses for 1979-2006 were stratified into quintiles using an area-based measure of SES and analysed by quinquennia (and 2004-06). IHD and stroke (rates per 100,000) adjusted for age, country of birth, and rurality were compared across SES strata (separately by sex) using Poisson regression. Mortality declined monotonically over the study period in all SES groups and both sexes. Absolute differences between low and high SES groups narrowed for IHD in females (27 to 23 per 100,000) and stroke in males and females (16 to 13, and 13 to 7 per 100,000, respectively), although absolute differences widened for IHD in males (52 to 63 per 100,000). Relative declines were greater in high compared to low SES groups for IHD (28% average quinquennial decline in high SES; compared with 21% in low SES for males; 30% and 21% for females), and for stroke (25% average quinquennial decline in high SES; 21% in low SES for males; 26% and 23% for females). Differences in mortality rates between lower and higher SES groups narrowed for both IHD (in females) and stroke (in males and females) from 1979-2006, indicating that the epidemic decline is now at a late stage when low SES groups are benefiting more, in absolute terms, than high SES groups. However males in the lower SES groups are still at an earlier stage of the epidemic decline in IHD mortality.

The Treatment of Coronary Heart Disease: An Update. Part 2: Mortality Trends and Main Causes of Death in the Greek Population

The Seven Countries Study, carried out in the 1960s, showed a low cardiovascular disease (CVD) mortality in the Greek population. Since then, although the age-adjusted all-cause mortality has gradually and steadily decreased, CVD mortality has increased, mainly due to a rise in ischaemic heart disease (IHD) mortality, and, more specifically, myocardial infarction (MI). The number of MIs per 100,000 men aged 30-69 years increased from 195 in 1981 to 297 in 1988 and from 35 to 52 in women, respectively. Age-adjusted IHD mortality in men aged 45-74 years almost doubled from 1956 to 1978. The rate of increase slowed down for a decade and since 1990 it has declined slightly. In women, the age-adjusted IHD mortality increased, but to a lesser degree until 1990, and then it started to decline. Cerebrovascular mortality was higher than IHD mortality in women and equal to IHD mortality in men in the late 1950s and early 1960s, but it started to decrease in 1972 in men, and in 1973 in women. Cancer mortality is the second commonest cause of death in both genders. Age-adjusted cancer mortality (in those aged 45-74 years) increased slightly in men until 1979 and then remained stable. In women, it remained stable until 1991 and then started to decline. The eradication of malaria and rheumatic fever, the decrease in infectious diseases, the improvement of the medical care system and the rise of the population's socio-economic level achieved during the last five decades in Greece have reduced all-cause mortality. On the other hand, the changes in lifestyle (lack of physical exercise, new dietary habits) have resulted in a higher IHD mortality. However, this increase is less than would be expected, taking into account the rise in blood cholesterol levels and the high prevalence of smoking. The recent small decline in IHD mortality is probably attributable to better treatment of IHD rather than to preventive measures.

The Treatment of Coronary Heart Disease: An Update Part 2: Mortality Trends and Main Causes of Death in the Greek Population

SUMMARYThe Seven Countries Study, carried out in the 1960s, showed a low cardiovascular disease (CVD) mortality in the Greek population. Since then, although the age-adjusted all-cause mortality has gradually and steadily decreased, CVD mortality has increased, mainly due to a rise in ischaemic heart disease (IHD) mortality, and, more specifically, myocardial infarction (MI). The number of MIs per 100000 men aged 30-69 years increased from 195 in 1981 to 297 in 1988 and from 35 to 52 in women, respectively. Age-adjusted IHD mortality in men aged 45-74 years almost doubled from 1956 to 1978. The rate of increase slowed down for a decade and since 1990 it has declined slightly. In women, the age-adjusted IHD mortality increased, but to a lesser degree until 1990, and then it started to decline. Cerebrovascular mortality was higher than IHD mortality in women and equal to IHD mortality in men in the late 1950s and early 1960s, but it started to decrease in 1972 in men, and in 1973 in women. Cancer mortality is the second commonest cause of death in both genders. Age-adjusted cancer mortality (in those aged 45-74 years) increased slightly in men until 1979 and then remained stable. In women, it remained stable until 1991 and then started to decline.The eradication of malaria and rheumatic fever, the decrease in infectious diseases, the improvement of the medical care system and the rise of the population's socio-economic level achieved during the last five decades in Greece have reduced all-cause mortality. On the other hand, the changes in lifestyle (lack of physical exercise, new dietary habits) have resulted in a higher IHD mortality. However, this increase is less than would be expected, taking into account the rise in blood cholesterol levels and the high prevalence of smoking. The recent small decline in IHD mortality is probably attributable to better treatment of IHD rather than to preventive measures.

Do changes in cardiovascular risk factors explain the increasing socioeconomic difference in mortality from ischaemic heart disease in Finland?

STUDY OBJECTIVE: To estimate the extent to which changes in blood pressure, smoking, and serum cholesterol concentration explain the observed increase in socioeconomic differences in mortality from ischaemic heart disease...

Trends in mortality, incidence and case fatality of ischaemic heart disease in Denmark, 1982-1992.

In Denmark, as in many other Western countries, a decline in mortality from ischaemic heart disease (IHD) has been observed. The present study assesses whether the decline in IHD mortality is due to a decrease in incidence and/or case-fatality, and whether parallel changes occurred in the various manifestations of IHD requiring hospitalization. The National Patient Register of hospital discharges and the Causes-of-Death Register were linked and all cases of first admission for IHD including AMI and fatal first manifestations of IHD since 1977 in the entire Danish population were identified. Cases of AMI and IHD were considered as incident cases if no admission for these diagnoses had occurred during the preceding 5 years. Sex-specific, age-standardized annual mortality, incidence and case-fatality rates of AMI (ICD8 code 410), narrowly defined IHD (NIHD, ICD8 codes 410-4) and broadly defined IHD (BIHD, ICD8 codes 410-4, 427 and 795-6) were calculated for the period 1982-1992. During the entire period the age-standardized mortality of AMI, NIHD and BIHD decreased in both men and women. The incidence of AMI and NIHD decreased, while the incidence of BIHD remained constant. Case fatality of AMI decreased in both men and women, while case fatality of NIHD and BIHD decreased in men and in women aged 0-64 years only. The declining mortality from IHD in Denmark may be partly due to declining incidence as well as declining case fatality, but changes in disease manifestation or diagnostic drift may also contribute because more broadly defined diagnostic groups showed less or no decline in incidence.

Ischaemic heart disease: trends in mortality in Hong Kong, 1970-89.

To describe the time trends for ischaemic heart disease (IHD) mortality in Hong Kong between 1970 and 1989, and to examine these trends in relation to the risk factors for IHD. A descriptive epidemiological study of time trends using mortality and population data from the Hong Kong Census and Statistics Department. Direct standardisation using the world population was made to adjust for the changing age structure. Log-linear analyses for trends were performed for the whole period and separately for 1970-79 and 1980-89. The cohort effect was studied by regrouping the data into five year groups according to the year of birth. The influences of risk factors, including hypertension, diet, and smoking, on the time trends of IHD were explored. The role of improved hospital treatment of myocardial infarction on the trends of mortality from categories of IHD was also examined. The total Hong Kong population, 1970-89. The substantial and steady decline of IHD mortality seen in most western countries in the past two decades was not observed in Hong Kong, which showed a plateau or slowly decreasing trend only in the past decade for both women and men. The decreasing trends were more apparent in the younger age groups, especially for women. Cohort analysis showed no significant cohort effect in men, but women born more recently had a lower mortality. Trends of risk factors did not show any close relationship with the mortality trends of IHD, except that a decrease in cigarette smoking might have contributed to the slight decrease in IHD mortality in recent years. Better detection and wider availability of treatment for hypertension might also have contributed to the decrease in IHD mortality. Hong Kong started to show a slow decline in IHD mortality during the 1980s, about one to two decades later than in other western countries and with the decreasing trend less pronounced. The reasons for this decline are not clear. More detailed information from systematic, population based surveys on life style and risk factors for IHD among the general population are needed.

Trends and Determinants of Ischaemic Heart Disease Mortality in Finland: with Special Reference to a Possible Levelling off in the Early 1980s

There has been a general decline in mortality from ischaemic heart disease (IHD) in Finland since the beginning of the 1970s. An intensified preventive programme was started in the province of North Karelia in 1972. Between 1974 and 1979 the decline in IHD mortality in North Karelian men was steeper than that in the rest of Finland. This favourable trend was associated with a fall in the levels of major coronary disease risk factors. Case-fatality from acute coronary events did not change much during this period. A levelling off in the decline in IHD mortality has been observed in the 1980s first in North Karelia and later in the whole of Finland. These findings from the official mortality statistics were confirmed in North Karelia by the data from the population-based coronary register. This levelling off in the decline in IHD mortality was associated with levelling off in risk-factor reductions in eastern Finland and with little improvement in risk-related behaviours in Finland during the 1980s. The IHD rates are still high and associated with persistent high risk factor levels and particularly with high serum cholesterol and blood pressure levels. Together with IHD mortality, the decline in total mortality also levelled off both in North Karelia and in the rest of Finland during the early 1980s. Compared with other countries, the rates of coronary disease and total mortality in the middle-aged Finnish population, especially among men, are among the highest in the world. New intensified actions have been taken in North Karelia and in the whole country to reduce risk factors further and to achieve further decline in IHD mortality. Future follow-up will reveal the success of these endeavours.

Trends and Determinants of Ischaemic Heart Disease Mortality in Finland: with Special Reference to a Possible Levelling off in the Early 1980s

There has been a general decline in mortality from ischaemic heart disease (IHD) in Finland since the beginning of the 1970s. An intensified preventive programme was started in the province of North Karelia in 1972. Between 1974 and 1979 the decline in IHD mortality in North Karelian men was steeper than that in the rest of Finland. This favourable trend was associated with a fall in the levels of major coronary disease risk factors. Case-fatality from acute coronary events did not change much during this period. A levelling off in the decline in IHD mortality has been observed in the 1980s first in North Karelia and later in the whole of Finland. These findings from the official mortality statistics were confirmed in North Karelia by the data from the population-based coronary register. This levelling off in the decline in IHD mortality was associated with levelling off in risk-factor reductions in eastern Finland and with little improvement in risk-related behaviours in Finland during the 1980s. The IHD rates are still high and associated with persistent high risk factor levels and particularly with high serum cholesterol and blood pressure levels. Together with IHD mortality, the decline in total mortality also levelled off both in North Karelia and in the rest of Finland during the early 1980s. Compared with other countries, the rates of coronary disease and total mortality in the middle-aged Finnish population, especially among men, are among the highest in the world.(ABSTRACT TRUNCATED AT 250 WORDS)

Trends in cardiovascular risk factors in Australia, 1966-1986: evidence from prevalence surveys.

AbstractA review of published data from cardiovascular risk factor surveys among adults in Australia from 1966 to 1983 suggests that:— prevalence of cigarette smoking decreased significantly by up to 1.4 per cent per year among men but increased among younger women;— serum cholesterol mean levels decreased significantly by 0.03 ‐ 0.04 mmol/1 per year among men and 0.04 ‐ 0.07 mmol/1 per year among women;— systolic blood pressure mean levels decreased significantly by 0.05 ‐ 0.3 mmHg per year among men and 0.2 ‐ 0.6 mmHg per year among women;— diastolic blood pressure showed no significant or consistent changes among men but some decrease among women.During the same period death rates from ischaemic heart disease (IHD) declined by over 40 per cent. The changes in risk factor levels are estimated to account for about half of the decline in IHD mortality for men and about three quarters of the decline for women.