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Global Success in CVD Prevention

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

 

Table 132 A. International Death Rates  (Per 100,000 Population) for heart disease in 1970 and 2000 and percent changes in men and women aged 35-74 years 1

Men

Women

Country 1970 2000 Change 1970 2000 Change
Australia 657 144 -78% 257 52 -80%
Canada 551 163 -70% 196 116 -41%
Finland 697 267 -62% 192 68 -65%
France 149 82 -45% 50 18 -54%
Italy 225 108 -52% 87 32 -63%
Japan 94 54 -33% 47 17 -64%
Mauritius 272 396 +46% 87 222 +155%
New Zealand 609 190 -69% 223 71 -68%
Russian Federation NA 835 NA NA 162 NA
Ukraine NA 867 NA NA 373 NA
UK 523 229 -56% 173 80 -54%
USA 657 216 -57% 257 90 -65%

 

  • 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.

 

Table 133 A. International Death Rates  (Per 100 000) for heart disease and stroke7

Country

Heart disease

Stroke

Men

Women

Men

Women

Russian Federation

706

237

351

189

England

138

32

32

27

United States

153

69

32

24

Canada

131

43

24

17

Australia

106

27

27

16

France

58

13

12

14

Switzerland

78

19

17

12

Urban China

108

72

160

103

Rural China

42

29

365

239

Japan

48

14

54

24

India NA

NA*

NA

NA

NA

AHA heart disease and stroke statics update 2011      NA= not available

 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.

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