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Background and aims In the 1960s and 1970s, Finland, mortality due to coronary heart disease (CHD) was over 30% higher among Finns residing in the east of the country compared with those residing in the west. Today, CHD mortality remains 20% higher among eastern Finns. The higher incidence of CHD mortality among eastern Finns has largely been explained by higher risk factor levels. Using a unique longitudinal cohort, we aimed to determine if participants who resided in eastern Finland during childhood had higher CHD risk factors in adulthood and from childhood to adulthood. Methods The study population included 2063 participants of the Cardiovascular Risk in Young Finns Study, born during the period 1962–1977, with risk factor data available from baseline (1980) when participants were aged 3–18 years, and had risk factor data collected again in adulthood (2011) when aged 34–49 years. Results Adult CHD risk factor profile was similar for those who resided in eastern or western Finland in childhood. Over life-course from 1980 to 2011, those subjects with childhood residency in eastern Finland had, on average, higher systolic (p = 0.006) and diastolic (p = 0.0009) blood pressures, total (p = 0.01) and LDL-cholesterol (p = 0.01), triglycerides (p = 0.04), apoB (p = 0.02), and serum glucose (p Conclusions Our sample of adult Finns aged 34–49 years had a similar CHD risk factor profile irrespective of whether they resided in eastern or western Finland during their childhood. However, when considering participants risk factor profiles over a 31-year period, those who resided in eastern Finland in childhood were associated with a less favorable CHD risk factor profile than those who resided in western Finland in childhood. The observed differences suggest that future CHD mortality might remain higher in eastern Finland compared with western Finland.

Background: Congenital heart disease (CHD) accounts for ≈40% of deaths in US children with birth defects. Previous US data from 1999 to 2006 demonstrated an overall decrease in CHD mortality. Our study aimed to assess current trends in US mortality related to CHD from infancy to adulthood over the past 19 years and determine differences by sex and race/ethnicity. Methods: We conducted an analysis of death certificates from 1999 to 2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculations for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals ≥1 year of age used US Census Bureau bridged-race population estimates as denominators. We used joinpoint regression to characterize temporal trends in all-cause mortality, mortality resulting directly attributable to and related to CHD by age, race/ethnicity, and sex. Results: There were 47.7 million deaths with 1 in 814 deaths attributable to CHD (n=58 599). Although all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those >65 years of age. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100 000. Males had higher mortality attributable to CHD than females throughout the study, although both sexes declined at a similar rate (≈40% overall), with a 3% to 4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all races/ethnicities studied, although disparities in mortality persisted for non-Hispanic Blacks versus non-Hispanic Whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100 000, respectively). Conclusions: Although overall US mortality attributable to CHD has decreased over the past 19 years, disparities in mortality persist for males in comparison with females and for non-Hispanic Blacks in comparison with non-Hispanic Whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.

BackgroundCongenital heart disease (CHD) accounts for approximately 40% percent of deaths in United States (US) children with birth defects. Previous US data from 1999-2006 demonstrated an overall decrease in CHD mortality. The objective of our study was to assess current trends in US mortality related to CHD from infancy to adulthood over the last 19 years and determine differences by sex and race/ethnicity.MethodsWe conducted an analysis of death certificates from 1999-2017 to calculate annual CHD mortality by age at death, race/ethnicity, and sex. Population estimates used as denominators in mortality rate calculation for infants were based on National Center for Health Statistics live birth data. Mortality rates in individuals>1 year of age utilized US Census Bureau bridged-race estimates as denominators for population estimates. We characterized temporal trends in all-cause mortality, mortality resulting directly due to and related to CHD by age, race/ethnicity, and sex using joinpoint regression.ResultsThere were 47.7 million deaths with 1 in 814 deaths due to CHD (n=58,599). While all-cause mortality decreased 16.4% across all ages, mortality resulting from CHD declined 39.4% overall. The mean annual decrease in CHD mortality was 2.6%, with the largest decrease for those age >65years. The age-adjusted mortality rate decreased from 1.37 to 0.83 per 100,000. Males had higher mortality due to CHD than females throughout the study, although both sexes declined at a similar rate (∼40% overall), with a 3-4% annual decrease between 1999 and 2009, followed by a slower annual decrease of 1.4% through 2017. Mortality resulting from CHD significantly declined among all race/ethnicities studied, although disparities in mortality persisted for non-Hispanic Blacks versus non-Hispanic Whites (mean annual decrease 2.3% versus 2.6%, respectively; age-adjusted mortality rate 1.67 to 1.05 versus 1.35 to 0.80 per 100,000, respectively).ConclusionsWhile overall US mortality due to CHD has decreased over the last 19 years, disparities in mortality persist for males compared to females and for non-Hispanic Blacks compared to non-Hispanic Whites. Determining factors that contribute to these disparities such as access to quality care, timely diagnosis, and maintenance of insurance will be important moving into the next decade.

We examined potential associations of sport club participation during adolescence and sports-related physical activity during adulthood with mortality from cardiovascular diseases (CVD) in a Japanese population. Between 1988 and 1990, 29,526 men and 41,043 women aged 40–79 years responded to a questionnaire including questions about the frequency of sports participation at baseline and sport club participation during junior/senior high school. Subjects were followed-up until the end of 2009, and 4230 cardiovascular deaths (870 CHD, 1859 stroke) were identified. Cox proportional-hazard regression models were used to estimate hazard ratios (HR). During the first-two thirds of the follow-up – where the proportional hazards assumption was met – the multivariate-adjusted HR (95% confidence interval) for total CVD mortality was 0.77 (0.61–0.98) among men and 0.82 (0.61–1.10) among women who were physically active at baseline (≥5 h/week versus 1–2 h/week). The corresponding HRs for coronary heart disease (CHD) mortality were 0.65 (0.39–1.07) and 0.40 (0.17–0.91), respectively. The combined associations of sports participation during adulthood and adolescence were also examined. Among men who participated in sports for ≥5 h/week at baseline, the multivariate-adjusted HR for those who also engaged in sport club activities during adolescence was 0.89 (0.61–1.30) for total CVD mortality and 0.24 (0.08–0.71) for CHD mortality when compared to non-participants. Among women, no statistically significant differences were found between sport club participants and non-participants. In conclusion, participating in sport clubs during adolescence might lead to a more pronounced risk-reduction for CHD mortality among men who also participate in sport activities during adulthood.

BackgroundCardiovascular disease (CVD) is the main cause of death in most industrialised countries, including those in Europe. The mortality rates due to coronary heart disease (CHD), one of the most serious CVD conditions, have been decreasing in most European countries during the last decades. However, whether the trends over time in CHD mortality rates differ depending on neighbourhood deprivation has rarely been investigated.MethodsFor each year of the study period, 1988–2012, in Sweden, age-standardised mortality rates were calculated for three different types of neighbourhoods, characterised by a Neighbourhood Deprivation Index. Joinpoint regression was used to investigate potential changes in age-standardised mortality rates by neighbourhood deprivation and over time.ResultsOver the study period, age-standardised mortality rates due to CHD were consistently the highest in the deprived neighbourhoods and the lowest in the affluent neighbourhoods. We observed a statistically significant overall decline, ranging from 67% to 59%, in the age-standardised CHD mortality rates for each level of neighbourhood deprivation. Furthermore, the decline for the affluent neighbourhoods was significantly higher compared with the decline in the deprived neighbourhoods.ConclusionAge-standardised CHD mortality rates decreased significantly in Sweden between 1988 and 2012. This decline was more pronounced in the affluent neighbourhoods, which indicates that the improvements in prevention and treatment of CHD have not benefited individuals residing in deprived neighbourhoods to an equal extent. Knowledge of time trends in CHD mortality by level of neighbourhood deprivation may help guide decision-makers in the development of appropriate healthcare policies for deprived neighbourhoods.

Background Heart disease (HD) is the leading cause of death among Mississippians. However, trends in mortality rates for HD subtypes in Mississippi have not been adequately described. This study examined trends in mortality rates for HD subtypes among adults in Mississippi from 1980 through 2013. Methods We used Mississippi Vital Statistics data to calculate age-specific mortality rates for HD subtypes for Mississippians age 35 and older. Cases were identified via underlying cause of death codes from the International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10). We used Joinpoint software to calculate the average annual percent change (AAPC) in mortality rates for HD subtypes by race, sex, and age group. Results Overall, the age-adjusted coronary heart disease (CHD) mortality rate among Mississippi adults decreased by 62.7% between 1980 and 2013, with an AAPC of −3.0% (95% CI −3.7 to −2.3), while the age-adjusted heart failure mortality rate increased by 66.7%, with an AAPC of 1.4% (95% CI 0.5 to 2.3). Trends varied across HD subtypes: Annual rates of hypertensive HD mortality increased significantly for men, for individuals age 35 to 54, and for individuals age 75 and older. CHD mortality experienced a significant annual decrease among all race, sex, and age subgroups, while heart failure increased significantly among women, whites, and individuals age 75 and older. Conclusions From 1980 to 2013, CHD mortality decreased significantly while heart failure mortality increased significantly among adult Mississippians. However, HD subtype trends differed by race, sex, and age group.

Ca and dairy product intakes may be inversely associated with all-cause and cause-specific mortality, and non-Ca components of dairy products, such as insulin-like growth factor-1, may be independently associated with mortality. We investigated associations of Ca and dairy product intakes with all-cause, all-cancer, colorectal cancer (CRC) and CHD mortality among 35 221 55- to 69-year-old women in the prospective Iowa Women’s Health Study, who were cancer-free in 1986. We assessed diet using a Willett FFQ, and associations using multivariable Cox proportional hazards regression. We estimated residuals from linear regression models of dairy products with dietary Ca to investigate total and specific dairy products independent of their Ca content. Through 2012, 18 687 participants died, including 4665 from cancer (including 574 from CRC) and 3603 from CHD. For those in the highest relative to the lowest quintiles of intake, the multivariable-adjusted hazard ratios (HR) and 95 % CI for total Ca (dietary plus supplemental) were 0·88 (0·83, 0·93; P trend=0·001) for all-cause mortality, 0·91 (0·81, 1·02; P trend=0·34) for all-cancer mortality, 0·60 (0·43, 0·83; P trend=0·002) for CRC mortality and 0·73 (0·64, 0·83; P trend

Background and objectives: Congenital Heart Disease (CHD) is the most common class of major congenital malformations. It is also the leading cause of mortality from birth defects. We used the Global Burden of Disease (GBD) 2017 study results to explore the burden of CHD in five countries of the Magrebian region. Methods: We estimated the most comprehensive of CHD mortality, prevalence, and disability among children (0–1 year), all ages and age standardized for the Magrebian countries from 1990 to 2017. The burden of disease related to CHD was calculated using the GBD comparative risk assessment approach. Results: CHD caused 4.622,87 (95% UI 3.801,24-7.580,28) all age deaths in Maghreb in 2017, a 50% decline from 1990, 661,02 (95% UI 310,96-933,58) rate per 100.000, among children (0-1 year) CHD deaths, a 42.4% decline from 1990 and 19,37 (95% UI 11,88-45,68) in age standardized CHD deaths a 40.6% decline from 1990. Leading to a 21.6% decrease from 1990 to 2017 in the number of people living with CHD to 727.01 (95% UI 631,28-1.098,29), causing a total of 397.060,97 (220.367,12-685.127,98) years lived with disability. Conclusion: This is the first study to estimate trends in CHD burden for the Maghreb from 1990 to 2017. These findings highlight the large inequities in CHD in the region and can serve as a starting point for policy changes leading to improved screening, treatment, and data collection. We call for Maghreb countries to invest more resources in prevention and health promotion efforts to reduce this burden.

Background: Previous studies have shown sex-specific differences in all-cause and CHD mortality in type 2 diabetes. We performed a systematic review and meta-analysis to provide a global picture of the estimated influence of type 2 diabetes on the risk of all-cause and CHD mortality in women versus men. Methods: We systematically searched PubMed, Embase, and Web of Science for studies published from their starting dates to 7 Aug 2018. The sex-specific hazard ratios (HRs) and their pooled ratio (women vs. men) of all-cause and CHD mortality associated with type 2 diabetes were obtained through an inverse-variance weighted random-effects meta-analysis. Subgroup analyses were used to explore potential sources of heterogeneity. Findings: The 35 analyzed prospective cohort studies included 2,314,292 individuals, among whom 254,038 all-cause deaths occurred. The pooled women vs. men ratio of the HRs for all-cause and CHD mortality were 1.17 (95% CI 1.12-1.23, I2=81.6%) and 1.97 (95% CI 1.49-2.61, I2=86.4%), respectively. The pooled estimate of the HR for all-cause mortality was approximately 1.30 in articles in which the duration of follow-up longer than 10 years, and 1.10 in articles in which the duration of follow-up less than 10 years. The pooled HRs for all-cause mortality in patients with type 2 diabetes was 2.33 (95% CI 2.02-2.69) in women and 1.91 (95% CI 1.72-2.12) in men, compared with their healthy counterparts. Interpretations: Women with type 2 diabetes have an approximately 17% and 97% greater additional risk of all-cause and CHD mortality than their men counterparts. Funding Statement: The study is supported by Natural Science Foundation of Zhejiang Province, K.C. Wong Magna Fund in Ningbo University, China Postdoctoral Science Foundation funded project, Jiangsu Postdoctoral Science Foundation funded project, Ningbo Scientific Innovation Team for Environmental Hazardous Factor Control and Prevention. Declaration of Interests: The authors declare no competing interest.

AimTo quantify the contribution of changes in different risk factors population levels and treatment uptake on the decline in CHD mortality in Denmark from 1991 to 2007 in different socioeconomic groups.DesignWe used IMPACTSEC, a previously validated policy model using data from different population registries.ParticipantsAll adults aged 25–84 years living in Denmark in 1991 and 2007.Main outcome measureDeaths prevented or postponed (DPP).ResultsThere were approximately 11,000 fewer CHD deaths in Denmark in 2007 than would be expected if the 1991 mortality rates had persisted. Higher mortality rates were observed in the lowest socioeconomic quintile. The highest absolute reduction in CHD mortality was seen in this group but the highest relative reduction was in the most affluent socioeconomic quintile. Overall, the IMPACTSEC model explained nearly two thirds of the decline in. Improved treatments accounted for approximately 25% with the least relative mortality reduction in the most deprived quintile. Risk factor improvements accounted for approximately 40% of the mortality decrease with similar gains across all socio-economic groups. The 36% gap in explaining all DPPs may reflect inaccurate data or risk factors not quantified in the current model.ConclusionsAccording to the IMPACTSEC model, the largest contribution to the CHD mortality decline in Denmark from 1991 to 2007 was from improvements in risk factors, with similar gains across all socio-economic groups. However, we found a clear socioeconomic trend for the treatment contribution favouring the most affluent groups.

Background : The Seven Countries Study in the 1960s showed very low mortality from coronary heart disease (CHD) in Japan, which was attributed to very low levels of total cholesterol. Studies of migrant Japanese to the USA in the 1970s documented increase in CHD rates, thus CHD mortality in Japan was expected to increase as their lifestyle became Westernized, yet CHD mortality has continued to decline since 1970. This study describes trends in CHD mortality and its risk factors since 1980 in Japan, contrasting those in other selected developed countries. Methods : We selected Australia, Canada, France, Japan, Spain, Sweden, the UK and the USA. CHD mortality between 1980 and 2007 was obtained from WHO Statistical Information System. National data on traditional risk factors during the same period were obtained from literature and national surveys. Results : Age-adjusted CHD mortality continuously declined between 1980 and 2007 in all these countries. The decline was accompanied by a constant fall in total cholesterol except Japan where total cholesterol continuously rose. In the birth cohort of individuals currently aged 50–69 years, levels of total cholesterol have been higher in Japan than in the USA, yet CHD mortality in Japan remained the lowest: >67% lower in men and > 75% lower in women compared with the USA. The direction and magnitude of changes in other risk factors were generally similar between Japan and the other countries. Conclusions : Decline in CHD mortality despite a continuous rise in total cholesterol is unique. The observation may suggest some protective factors unique to Japanese.

In this work a Mathematical model is proposed to study the relationship between sh consumption and coronary heart disease (CHD) mortality in Morocco. The aim of this study is to investigate CHD mortality depending on various sh consumption levels by proposing dierent scenarios. The mathematical model is based on ordinary dierential equations system. The dynamics of a population at risk of CHD, the dynamics of sh population living along the Moroccan coasts, the relationship between CHD mortality and the quantities consumed from the total caught in Morocco are studied. Furthermore, simulation is carried out with different scenarios depending on the total sh harvested and total sh consumed. This model highlights the negative correlation between CHD mortality and sh consumption. Mathematics Subject Classication: 92B05

Background Cardiovascular disease mortality rates are well-known to be lower in women than men and to increase with age. Whether these sex and age effects have changed over recent decades, and how much they differ by country, is unclear. Method From the WHO Mortality Database, we obtained age- and sex-specific CHD and stroke mortality rates for the world's most populous countries with data available between 1980 and 2010. We calculated age, country, and period-specific men-to-women mortality CHD and stroke mortality rate ratios for 26 countries and compared the differences between and within countries over time. Results Coronary heart disease (CHD) and stroke mortality decreased substantially between 1980 and 2010 in most countries, in both sexes. Mostly there was an attenuation of the effect of ageing over calendar time, more so in men than in women. CHD mortality was higher in men than in women throughout adulthood, but the magnitude of the difference varied by age. Men-to-women CHD mortality rate ratios were 4- 5 in middle age and 2 thereafter. Stroke mortality was more similar between sexes, with men-to-women stroke mortality rate ratios of around 1.5 to 2 until old age. Conclusion While CHD and stroke mortality rates declined considerably between 1980 and 2010 in both sexes, there was some indication for stronger age-specific reductions in CHD in men than women. Mortality from CHD and stroke remains higher among men than women until old age across a range of economically, socially, and culturally diverse countries.

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.

There are substantial geographic variations in coronary heart disease (CHD) mortality rates in England that may in part be due to differences in climate and air pollution. An ecological cross-sectional multi-level analysis of male and female CHD mortality rates in all wards in England (1999-2004) was conducted to estimate the relative strength of the association between CHD mortality rates and three aspects of the physical environment - temperature, hours of sunshine and air quality. Models were adjusted for deprivation, and index measuring the healthiness of the lifestyle of populations, and urbanicity. In the fully adjusted model, air quality was not significantly associated with CHD mortality rates, but temperature and sunshine were both significantly negatively associated (p

Background Information 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. Methods The 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. Results The 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. Conclusions In 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.

This manuscript reviewed racial/ethnic differences in dyslipidemia, including prevalence of dyslipidemia, its relation to CHD and stroke mortality rates, response to lipid-lowering agents, and lifestyle modification. In particular, among all racial/ethnic groups, Asian Indians, Filipinos and Hispanics are at higher risk for dyslipidemia, which is consistent with the higher coronary heart disease (CHD) mortality rates in these groups. In addition, compared to other racial/ethnic groups, statins may have a higher efficacy for Asians. Studies suggest lower starting dosage in Asians, but the data are mixed. Genetic differences in statin metabolism can in part explain this racial/ethnic difference in statin sensitivity and adverse effects. Furthermore, lifestyle modification is recommended as part of dyslipidemia control and management. Both African Americans and Hispanics have more sedentary behavior and less favorable diet profile. Hispanic subgroups (i.e. Mexican, Puerto Rican, etc.) and Asian (i.e. Chinese, South Asian, etc.) subgroups should be disaggregated for lifestyle interventions due to cultural differences among the subgroups. Further studies are needed to better understand racial/ethnic-specific risk factors contributing to the observed differences in dyslipidemia, CHD, and stroke. Culturally-tailored prevention and intervention should be provided to the minority populations with elevated risk for dyslipidemia and considerably more research is needed to determine the best approaches to helping specific subgroups.

OBJECTIVES We analyzed all-cause and coronary mortality data of the Turkish Adult Risk Factor Study cohort in Marmara and Central Anatolia regions, surveyed in 2011, and overall performance of long-term (21 years) follow-up of participants. STUDY DESIGN A total of 1,588 participants with an age range of 45 to 74 years were surveyed. Information on the mode of death was obtained from first-degree relatives and/or personnel of local health offices. Information on survivors was obtained from history, physical examination, and 12-lead electrocardiograms. Loss to follow-up was defined as the lack of physical examination for at least eight years. RESULTS Of the surveyed participants, 854 were examined, information on health status was obtained in 606 subjects, 46 individuals (28 men, 18 women) were ascertained to have died, and 82 subjects were lost to follow-up. A total of 2,800 person-years were added to follow-up. Nineteen deaths were attributed to coronary heart disease (CHD) and five deaths to cerebrovascular events. Overall mortality was estimated as 10.9 per 1000 person-years. In the age bracket of 45-74 years, overall annual all-cause mortality and CHD mortality were 12.8 and 5.5 per mille, respectively. Based on the total loss to follow-up (31.2%) during the past two decades, an annual loss to follow-up may be derived as 19.3 for every 1000 participants. This loss was nearly twice as high in participants living in big cities compared to those in smaller towns and rural areas. CONCLUSION A trend to slight reduction in coronary mortality, though not in overall mortality, before the age 75 years is noted in Turks. Annual loss to follow-up amounts to 2% of the participants.

Objectives. We examined the extent to which the decrease in coronary heart disease (CHD) mortality rates in Italy could be explained by changes in cardiovascular risk factors versus the use of medical and surgical treatments. Methods. We used a validated model to combine data on changes in risk factors and uptake and effectiveness of cardiac treatments among adult men and women in Italy between 1980 and 2000. Data sources included results of published trials, meta-analyses, official statistics, longitudinal studies, and national surveys. The difference between observed and expected CHD deaths in 2000 was partitioned among treatments and risk factors. Results. From 1980 to 2000, the age-adjusted CHD mortality rate in Italy fell among persons aged 25 to 84 years, resulting in 42 930 fewer CHD deaths in 2000. Approximately 40% of this decrease was attributed to treatments and 55% to changes in risk factors. Conclusions. Over half of the CHD mortality fall in Italy between 1980 and 2000 was attributable to reductions in major risk factors, mainly cholesterol and blood pressure, and less than half to evidence-based medical therapies. These results are becoming increasingly important, both for understanding past trends and for planning future prevention and treatment strategies.

ObjectiveTo test whether change in the frequency of fish intake at population level would affect the trends of death from CHD and how many CHD events could be prevented in Hong Kong, a population among those with the highest fish consumption and the lowest CHD mortality in the world.DesignTime trends analysis with data from repeated dietary surveys and death registration.SettingHong Kong SAR, People’s Republic of China.SubjectsA total of 3096 men and women aged 40–69 years who participated in territory-wide surveys in 1995 or 2003 were included in the analysis of changes in dietary fish intake; all adults aged 40–69 years in Hong Kong were included in the analysis of time trends of CHD mortality.ResultsOver the period, the frequency of fish intake increased and CHD mortality decreased significantly in the population age group of 50–69 years, while in the age group of 40–49 years little change in both fish intake and CHD mortality was observed. It was estimated that 240 CHD deaths (or 29 % of the total) were avoided among the population aged 40–69 years in 2003, as more than half of the population consumed fish every day in Hong Kong.ConclusionsThe time trend of CHD mortality was inversely related to the trend of fish intake. The frequency of fish intake may have a substantial impact on the population for the prevention of CHD deaths in Hong Kong.

Medical and epidemiological research into the aetiology of CHD has drawn attention to the likely causal role of certain risk factors, especially elevated serum (LDL) cholesterol and blood pressure levels, and smoking. Conventional trials to establish the causality have come up against problems of feasibility and study design. Community-based studies have considerable potential in introducing changes to the general lifestyle and risk factors in large numbers of people (since the risk factors are closely related to the way of life and other features of the community). Thus a well evaluated community-based study can augment our knowledge on the role of the risk factors. Furthermore, a community study examines how the existing service structure and community resources can be used and assesses the overall feasibility and consequences of such an intervention. The North Karelia project, started in eastern Finland in 1972, has been a major communitybased study on the prevention of CHD. The results of the 10-year evaluation of the project illustrate the feasibility and consequences of the approach. During the 10-year period 1972—82 the following net changes (i.e. adjusted for changes in the reference area) occurred in the risk factor means of the population aged 30—59 in North-Karelia: —28% for smoking (p

The association between socioeconomic status, measured by a combination of income and education, and CHD mortality has been studied in a cohort of 40–49 year old Oslo men. Socio–economic status was significantly associated with CHD mortality. However, the lowest CHD mortality was found in social status Group III (middle class) and this could not be explained by the risk factor gradients seen among those studied. Although the number of fatalities is small (68 CHD deaths during 4.5 years) socio–economic status seems to be independently associated with coronary risk after adjusting for serum cholesterol, systolic blood pressure and cigarette smoking.

Background: Finland, Ireland and the United Kingdom have the highest rates of coronary heart disease (CHD) mortality among EU-15 countries. This study examines the pace of change in CHD mortality in these countries from 1985–2006. Methods: The percentage change in 5-year average all age, under 65 and 65 years and over age standardized mortality rates from 1985–89 to 2002–06 was calculated for each country. Joinpoint regression analysis was used to analyse age standardized mortality rates to identify points (years) where the slope of the linear trend changed significantly. The pace of change in the CHD mortality rate was measured using annual percentage change (APC). Results: The percentage change in 5-year age standardized (under 65) CHD mortality rates was similar in Finland and the UK for both genders whereas in Ireland the rate of change was greater, especially for females. The percentage change in ≥65 year and all age rates was between 8.2% and 12.4% lower for Finnish males, and between 11.6% and 13% lower for Finnish females compared to their Irish and UK counterparts. There were different turning points in the downward trend in CHD mortality across the three countries varying from 1991–2003. The APC in CHD mortality after the turning point was greatest for Irish males (all age = −7.3%, under 65 = −8.2% and 65 and over = −7.1%), and Irish females (under 65 = −7.2%). Conclusion: We have identified differing pace of decline in three countries with similar burden of disease and successful national strategies to control CHD.

Background and Aims Country of birth provides a proxy for ethnic group for recent migrants. Major differences in mortality by country of birth have been demonstrated in England and Wales, but similar published data for Scotland are lacking. We aimed to examine variations in mortality by country of birth for Scottish residents. Methods We calculated standardised mortality ratios by country of birth for Scottish residents aged 25 years and over between January 1997 and March 2003. Results and Conclusion Comparisons with England and Wales showed high allcause, coronary heart disease (CHD) and stroke mortality among Scottish residents born in Scotland, Northern Ireland, the Republic of Ireland, India and Hong Kong. However, most country of birth groups had similar or lower mortality than the Scottish born. These are the first data on mortality by country of birth in Scotland and they demonstrate major variations. Comparisons within the Scottish population might be interpreted as reassuring, since they do not show the excesses in CHD mortality by country of birth reported in England and Wales. However, the use of England and Wales as a comparison group shows a substantial excess of CHD risk among South Asians in Scotland, comparable to that reported in England and Wales.

Panel data methods are used to investigate how deaths from coronary heart disease (CHD) in the United States vary with macroeconomic conditions. A one-percentage-point reduction in unemployment is predicted to raise CHD mortality by 0.75%, corresponding to almost 3,900 additional fatalities. The increase in relative risk is similar across age groups, implying that senior citizens account for most of the extra deaths. Direct evidence is obtained of a role for decreases in medical interventions treating coronary problems. CHD mortality increases rapidly when the economy strengthens but returns to or near its baseline level within five years for most groups.

Background Coronary heart disease (CHD) is a major cause of premature mortality, particularly in deprived groups. Might recent declines in overall mortality obscure different rates of decline among social strata, creating potentially misleading views on inequalities? Methods We used a Bayesian analysis of an age–period–cohort model for the English population. We projected age-specific premature CHD mortality (ages 35–74) by gender and area-based deprivation status for the period 2007–2035, using 1982–2006 as the input. Deprivation status was measured by Index of Multiple Deprivation quintiles, which aggregate seven types of deprivation, including health and income. We analysed inequality in premature CHD mortality. We investigated the annual changes in inequality and the contributions of changes in each IMDQ to the overall annual changes, using both absolute (probability) and relative (logit) scales. We quantified inequality using the statistical variance in the probability of premature death among deprivation quintiles. Results The overall premature CHD mortality trends conceal marked heterogeneities. Our models predict more rapid declines in premature CHD mortality for the most affluent quintiles than for the most deprived (annualized rate of decline 2006–2025, 7.5% [95% Credible Interval 4.3–10.5%] versus 5.4% [2.2–8.7%] for men, and 6.3% [3.0–9.9%] versus 5.9% [1.5–10.8%] for women). For men, the posterior probability that the rate of decline is greater for the most affluent was 82%. Variance in premature CHD mortality across deprivation quintiles was projected to decrease by approximately 81% [28–95%] among men and by 89% [30–99%] among women. This decrease was particularly driven by the most deprived groups due to their higher premature death rates. However, relative inequality was projected to rise by 93% among men [81–125%] and rise by 13% [−25–58%] among women. These increases are also mostly influenced by the most deprived, reflecting their slower declines in premature deaths. Conclusions Overall, premature coronary death rates in England continue to decline steeply. Absolute inequalities are decreasing, reflecting declines in the high premature mortality in deprived groups. However, relative inequalities are projected to widen further, reflecting slower mortality declines in the most deprived groups. More aggressive and progressive prevention policies are urgently needed.

Background -Among primary coronary heart disease (CHD) risk factors, certain socioeconomic characteristics of individuals and living environments appear to play a central role. The objective of this study was to assess the burden of neighbourhood deprivation-associated excess in mortality and hospital admission from CHD in Plymouth. Methods - A small area ecological study using indices of neighbourhood deprivation and coronary heart disease mortality and hospital admission data aggregated for 1991-2003 for CHD mortality and for 1997-2004 for CHD hospital admission. Locally defined community areas (n = 43) were classified according to the Townsend index, measuring material deprivation. Results - CHD mortality and hospital admission increased with Townsend deprivation score in all ages and gender groups.The age-adjusted deprivation-associated excess CHD hospital admission was 15.4% in men and 27.9% in women higher for most compared to the least deprived group. The age-adjusted deprivation-associated excess CHD mortality was 31.5% and 18.9% for men and women, respectively. Excess mortality in the 13-year period studied accounted for more than 1380 and 670 deaths for men and women. Excess hospital admissions in the 7-year period studied accounted for more than 966 and 769 hospital admissions for men and women. A larger proportion of excess CHD deaths were found among men while excess CHD hospital admissions were found among women. The most deprived areas showed the highest mortality and hospital admission risk. Conclusion - Despite the existence of a system of universal health care, inequalities in CHD mortality and hospital admission persist and need to be taken into account when implementing intervention programmes.

Background Although the major risk factors for coronary heart disease (CHD) are well-established, intense efforts persist in the search for "novel" or "emerging" risk factors because of the notion that as many as half of CHD victims may not have the traditional risk factors. Objective Compare prevalences of major risk factors among persons with fatal CHD in a nationally representative population sample. Methods Baseline data from the Second National Health and Nutrition Examination Survey and 17-year follow-up mortality data were examined for 8,069 adults (3,701 men; 4,368 women) aged 30 to 75 years in 1976–1980. We calculated sex-specific prevalences of hypertension, elevated total cholesterol (≥240 mg/dL), cigarette smoking, and the presence of at least one of these three major risk factors. The relative risk of death from CHD associated with the three major risk factors was calculated in sex-specific multivariable models adjusted for age, race, and education. Results Overall, nearly 75% of US adults had at least one of the three major risk factors. Those who died of CHD, compared to those who did not die of CHD, had respectively, greater prevalences of hypertension (men: 48% vs. 38%; women: 76% vs. 33%). Similarly, persons who had fatal CHD were more likely to have elevated total cholesterol (men: 53% vs. 30%; women: 55% vs. 34%), although the finding was not statistically significant in women. Smoking prevalence was also greater among persons who died of CHD than those who did not for both men (64% vs. 40%) and women (43% vs. 33%). The proportion of persons with at least one of the three major risk factors was significantly ( P ≤0.01) greater among those who died from CHD compared with those who did not (men: 92% vs. 74%; women: 98% vs. 70%). The risk of fatal CHD was 51% lower among men and 71% lower among women with none of the 3 risk factors compared to those with at least one. Had all three major risk factors not occurred, 64% of all CHD deaths among women and 45% of all CHD deaths among men could have been avoided. Conclusions Nine out of ten US adults who died of CHD had at least one of the three major established risk factors. Thus, the notion that many CHD victims do not have the traditional risk factors is a misconception. Policies and strategies that increase the prevalence of a low risk profile are needed, and aggressive efforts in the prevention and control of the major established risk factors remain the key to continued reductions in CHD mortality.

OBJECTIVE: Seasonal variations in coronary heart disease (CHD) and related risk factors have been reported previously. However, no studies to date quantify the contribution of seasonal variations in risk factors to actual mortality in both men and women using a single database of sufficient size and follow-up. METHODS: We investigated the database from the Western Austrian Vorarlberg Health Monitoring and Promotion Programme (VHM&PP) including over 450,000 repeated measurements of 149,650 individuals between 1985 and 1999. RESULTS: Of a total of 1266 deaths from CHD (ICD-9 410–414), 353 deaths occurred between December and February (27.9%), in contrast to 275 (21.7%) between June and August. While the frequency of deaths through acute myocardial infarction (ICD-9 410) was similar over the seasons, chronic forms of CHD (ICD-9 414) occurred significantly (p < 0.001) more frequently in winter. Total cholesterol, blood pressure and body mass index showed pronounced seasonal variations with average levels significantly higher during the winter months in all age groups and both sexes, giving an estimated increase in SCORE risk of 6.8% in men and 3.6% in women. However by contrast, use of single time point risk factor data tended to overestimate subsequent 10-year mortality if measured in winter and the converse in summer. CONCLUSION: For the first time, this study quantifies the contribution of seasonal risk factor variation to CHD mortality. The consistent effect across demographic groups suggests that this is a real physiological phenomenon and not an artefact of living conditions. Interpretation of standard risk scores should take account of this seasonal fluctuation in subsequent investigation and follow-up.

A sharp decline in cardiovascular mortality has been observed over the last 15 years in the Czech Republic. This article compares epidemiological data of infection incidence and seropositivity (which may have influenced the decline) with coronary heart disease (CHD) mortality. No association between the change in CHD mortality and infections was found. In conclusion, the influence of a single infection on atherogenesis is improbable.

When it comes to cross-cultural comparisons of rates of coronary heart disease (CHD), the Japanese have commonly been used as a contrast with the US (and most of Western Europe). According to 2011 CHD mortality data from the American Heart Association [1], the rates per 100,000 population for men and women (aged 35–74 years) in Japan are 47 and 12.6 and in the US are 132 and 51.6, respectively—65% lower in men and 76% lower in women. This difference is also apparent in randomized trials. Comparing 2 studies on the effects of omega-3 fatty acid treatment on CHD events in patients with known CHD—a sub-cohort from the Japan EPA Lipid Intervention Study (JELIS [2]) and the GISSI-Prevenzione Study [3] (performed in Italy)—death rates per 1000 personyears in the control groups were 2.5 vs. 17; 85% lower in the Japanese study [4]. What is remarkable is that these marked differences would not be predicted from risk factor profiles. Sekikawa et al. have examined both CHD risk factors and subclinical disease [coronary artery calcification (CAC) and intima-media thickness of the carotid artery (IMT)] in population-based cohorts of Japanese and US men [5–8]. The Japanese men have higher blood pressures and rates of smoking than the US men [5]. Rates of diabetes and levels of LDL-cholesterol are similar. Despite these differences, CAC and IMT are significantly lower in the Japanese men. In this issue of Trends in Cardiovascular Medicine, Sekikawa et al. [9] highlight these differences and in that light, address the spate of recent RCTs (virtually all of which have been conducted in European or North American cohorts) which have failed to show a benefit of omega-3 fatty acids in CHD [10]. These authors propose that the combination of low dietary fish intakes and the

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: –]]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.

Aims: Lithuanian middle-aged men have a fourfold higher risk for coronary heart disease (CHD) mortality compared with Swedish men. In Sweden, CHD mortality is twice as high in blue- compared with white-collar workers. Whether the same risk factors that characterized Lithuanian men, compared with Swedish men, could be found in low socioeconomic groups within the cities was investigated. Methods : The LiVicordia study compared both traditional and new possible risk factors for CHD among 150 50-year-old men in Linköping, Sweden and Vilnius, Lithuania. A comparison was made of the prevalence of these risk factors in high and low socioeconomic groups within the cities and, after controlling for the city, variations across socioeconomic groups in the total sample. Results: Small differences were found in traditional risk factors between cities. However, Vilnius men were shorter, had lower serum levels of antioxidant vitamins, more psychosocial strain, and lower cortisol response to a standardized laboratory stress test. These characteristics were also found among men in low social classes in both cities. In linear regression models, short stature, low serum β-carotene, low social integration, coping and self-esteem, high vital exhaustion, high baseline and low cortisol response to stress were related to low social class. Conclusions: The same set of risk factors, mainly relating to oxidative and psychosocial stress, that characterized Vilnius men was also found in men in low social classes within the cities. The results suggest that a common set of risk factors may help to explain health differences both between and within countries.

The levels of risk factors for coronary heart disease (CHD) in men in the post World War II (WWII) birth cohort are almost similar between Japan and the USA, except for the considerably higher prevalence of cigarette smoking in Japan and the much higher prevalence of obesity in the USA. The present study evaluated the CHD mortality among men in the post WWII birth cohort by prefecture in Japan in 1995-1999 and then compared the data with those for white men in different states in the USA. There was a greater than 2-fold difference in CHD mortality among men aged 35-44 by prefecture in Japan: 5.3/100,000 in Kumamoto vs 12.6/100,000 in Tochigi. CHD mortality among men aged 35-44 in the top 3 prefectures in Japan is about half that of white men in the USA and is similar to that of white men in the lowest 3 states. The much lower CHD mortality in Japan does not appear to be caused by differences in the classification of causes of death and the results suggest that there may be strong and important protective factors that reduce the risk of CHD in Japan.

Summary Background The revolution in coronary care in the mid-1980s to mid-1990s corresponded with monitoring of coronary heart disease (CHD) in 31 populations of the WHO MONICA Project. We studied the impact of this revolution on coronary endpoints. Methods Case fatality, coronary-event rates, and CHD mortality were monitored in men and women aged 35–64 years in two separate 3–4-year periods. In each period, we recorded percentage use of eight treatments: coronary-artery reperfusion before, thrombolytics during, and β-blockers, antiplatelet drugs, and angiotensin-converting-enzyme (ACE) inhibitors before and during non-fatal myocardial infarction. Values were averaged to produce treatment scores. We correlated changes across populations, and regressed changes in coronary endpoints on changes in treatment scores. Findings Treatment changes correlated positively with each other but inversely with change in coronary endpoints. By regression, for the common average treatment change of 20, case fatality fell by 19% (95% Cl 12–26) in men and 16% (5–27) in women; coronary-event rates fell by 25% (16–35) and 23% (7–39); and CHD mortality rates fell by 42% (31–53) and 34% (17–50). The regression model explained an estimated 61% and 41% of variance for men and women in trends for case fatality, 52% and 30% for coronary-event rates, and 72% and 56% for CHD mortality. Interpretation Changes in coronary care and secondary prevention were strongly linked with declining coronary endpoints. Scores and benefits followed a geographical east-to-west gradient. The apparent effects of the treatment might be exaggerated by other changes in economically successful populations, so their specificity needs further assessment.

PURPOSE: This study examined racial variations in CHD (coronary heart disease) mortality rates (1968–1992) of residents aged 35–84 in the state economic areas (SEAs) surrounding the ARIC (Atherosclerosis Risk in Communities) study. The quarter century of CHD mortality rates are discussed in relation to racial and gender differences in baseline risk factors measured in the ARIC cohort and to the incidence of hospitalized myocardial infarction and case fatality rates obtained from the community surveillance component of the ARIC study between 1987 and 1994, inclusive. METHODS: Five-year average annual, gender- and age-specific CHD mortality rates were compared across race groups, based on National Vital Statistics data for state economic areas. RESULTS: Five-year average annual CHD mortality declined 2.6% for white men and women and 1.6% and 2.2% for black men and women, respectively. The black-white mortality rate ratio increased over time for men and women. The black-white mortality age crossover (higher black than white mortality in young men, lower black than white mortality at older ages) had disappeared by the end of the observation. CHD mortality was markedly greater in black than white women at all ages and time periods. The black disadvantage in CHD mortality was increasingly greater in the ARIC SEAs than in the United States as a whole. CONCLUSIONS: Persistent and increasing racial disparities in CHD mortality occurred in the ARIC SEAs concurrently with racial differences in risk factors, the incidence of myocardial infarction, and case fatality rates.

Objective . This study aimed to examine the correspondence between seven established risk factors for coronary heart disease (CHD) and CHD mortality among the states in the United States. An ecologic analysis relating CHD risk factor prevalences to CHD mortality rates among 49 states was undertaken in 1991–1992. Methods . Approximately 68,000 men and women ages 45–74 were randomly sampled and interviewed by telephone in surveys conducted in 49 states in 1991 and 1992. From these interviews, we estimated state-specific prevalences of smoking, overweight, physical inactivity, hypertension, elevated cholesterol, diabetes, and alcohol abstinence. These seven CHD risk factors were also combined to create a CHD risk index for each state. The main outcome measures were mortality rates from CHD (ICD9 codes 410.0–414.9) in each of 49 states in 1991–1992 for men and women ages 45–74. The analysis was based on multiple linear regression and Spearman's rank-order correlations between the CHD risk factor prevalences, the combined CHD risk index, and the CHD mortality rates among the 49 states. Results . The prevalences of most of the CHD risk factors correlated with CHD mortality rates in the expected directions, and correlations were similar for men and women. The CHD risk index correlated strongly with CHD mortality for both men ( r = 0.75) and women ( r = 0.80). Conclusion . About 60% of the variance in CHD mortality between the states in the United States (56% for men and 64% for women) is attributable to differences between the states in the prevalences of seven established risk factors for CHD. As state health agencies prioritize resources for chronic disease prevention programs, they should consider the potential benefits of increased efforts to reduce the prevalences of modifiable CHD risk factors in their populations to reduce CHD mortality.

PURPOSE: To examine the association between coronary heart disease (CHD) mortality, economic and medical resources, and county occupational structure. METHODS: U.S. counties were classified into five occupational structure categories based on the percentage of workers in white-collar occupations. Directly age-adjusted CHD mortality rates (from vital statistics and Census data) and economic and medical care data (from Census and Area Resource File data) were calculated for each occupational structure category. Participants were black and white, men and women, aged 35–64 years, in the U.S. during 1980–88. CHD mortality rates and economic and medical care data were compared across occupational structure categories. RESULTS: Among blacks, CDH rates were highest in counties with intermediate levels of occupational structure; rates among whites were inversely associated with occupational structure. Per capita levels of income and numbers of medical-care providers were positively associated with occupational structure. CONCLUSION: Strategies to improve the resources of disadvantaged communities and the access of black workers to local occupational opportunities may be important for CHD prevention in high risk populations.

A comparison of coronary heart disease (CHD) mortality in two large American Cancer Society studies, Cancer Prevention Study (CPS) I (1959–1965) and CPS-II (1982–1988) suggests that surprisingly large declines occurred in two groups so defined to minimize the influence of change of smoking status. CHD mortality fell essentially in half when comparing nearly 300,000 persons who were actively smoking cigarettes at entry into CPS-I with about 228,000 persons who were similarly actively smoking at entry into CPS-II, about 20 years later. CHD mortality also declined by more than 50% among nearly half a million lifelong nonsmokers recruited for CPS-I in the early 1960s and for CPS-II in the mid-1980s. Possible explanations for these large declines include unmeasured decreases in smoking related to trial design, errors in ascertainment of causes of death, greater improvement among smokers of other risk factors for CHD, and changes in cigarettes or the pattern of smoking that have been salutary for CHD, but not for lung disease or lung cancer; none of these putative explanations can be supported by data from these studies. CHD mortality, much lower in absolute terms in recent years, is still much higher among smokers vs nonsmokers, so that the beneficial trends observed from CPS-I to CPS-II should stimulate further exploration of how CHD is related to smoking, and not serve as an excuse to ignore continued smoking.

OBJECTIVES: To investigate the characteristics of earthquake (EQ)-induced coronary heart disease (CHD) deaths. SETTING AND PARTICIPANTS: On January 17, 1995, the south part of Hyogo Prefecture in Japan was struck by a major EQ (Hanshin-Awaji EQ) measuring 7.2 on the Richter scale. We investigated the characteristics of EQ-induced CHD deaths (myocardial infarction and sudden death) in the Tsuna region, which is a community with a large older population (31% of the total of 64,000 residents are 60 years of age or older) and includes the epicenter and one of the most heavily damaged areas. MEASUREMENTS: EQ-related CHD mortality on the basis of direct access to records of physicians who were able to continue services for the EQ victims without interruption by this disaster situation. RESULTS: Coronary heart disease deaths increased for a few months after the EQ, and the total number from January 17 to April 30,1995, was 45, which was significantly (1.5 times) higher than the 31 deaths during the same period of the previous year (1994). The CHD deaths after the EQ all occurred in individuals more than 60 years of age and had a positive correlation with EQ-induced damages. Concerning the onset time, CHD deaths occurred 1.8 times more often (P < .05) in the nighttime (11 PM to 5 AM) and 1.4 times as often during the morning (5 AM to 11 AM), whereas their occurrence did not vary during a 12-hour period from 11 AM to 11 PM. CONCLUSION: Deaths of older individuals from CHD persisted for a few months after the EQ and were especially prominent during the nighttime and morning. Reduction of stress and related coronary risk factors in this period may suppress CHD deaths after a major EQ.

Associations of body mass index (BMI), two measures of percent body fat derived from skin-folds, body weight adjusted for height, triceps and subscapular skinfolds, and their sum, with 22-year coronary heart disease (CHD) mortality were compared in 1707 white men ages 40–55 years at baseline (1958) and free of CHD and cancer in 1961 in the Western Electric Study. Because associations of adiposity measures with CHD mortality differed by length of follow-up, analyses were conducted separately for the first 14 years of follow-up and years 15 through 22. In Cox regression analyses, none of the adiposity measures was significantly related to CHD mortality for the first 14 years of follow-up. For years 15–22, all adiposity measures, except triceps skinfold, were significantly related with adjustment for age, as well as eight other covariates. These results indicate that a positive relation of adiposity to CHD risk may not become apparent until several years after the assessment of adiposity.

Coronary heart disease (CHD) mortality has declined substantially in the Czech Republic over the last two decades.The purpose of this study was to determine what proportion of this CHD mortality decline could be associated with temporal trends in major CHD risk factors and what proportion with advances in medical and surgical treatments.The validated IMPACT mortality model was used to combine and analyse data on uptake and effectiveness of CHD management and risk factor trends in the Czech Republic in adults aged 25-74 years between 1985 and 2007. The main sources were official statistics, national quality of care registries, published trials and meta-analyses, and the Czech MONICA and Czech post-MONICA studies.Between 1985 and 2007, age-adjusted CHD mortality rates in the Czech Republic decreased by 66.2% in men and 65.4% in women in the age group 25-74 years, representing 12,080 fewer CHD deaths in 2007. Changes in CHD risk factors explained approximately 52% of the total mortality decrease, and improvements in medical treatments approximately 43%. Increases in body mass index and in diabetes prevalence had a negative impact, increasing CHD mortality by approximately 1% and 5%, respectively.More than half of the very substantial fall in CHD mortality in the Czech Republic between 1985 and 2007 was attributable to reduction in major cardiovascular risk factors. Improvement in treatments accounted for approximately 43% of the total mortality decrease. These findings emphasize the value of primary prevention and evidence-based medical treatment.

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.HighlightRisk factor reduction explains major part of CHD mortality decline in Eastern FinlandKey for prevention is population wide risk factor reduction through lifestyle changesPopulation based prevention is the most cost effective and sustainable way to improve heart health

I burdens. This suggests that focus on nsuffi cient omega-6 polyunsaturated increasing healthful n-6 rich vegetable fatty acids (n-6 PUFA), excess trans fat oils may provide important public health and, to a lesser extent, excess saturatbenefits,” Qianyi Wang, ScD, and her ed fat, are signifi cant causes of coronary colleagues said. heart disease, suggests a global study The researchers estimated national recently published online. intakes of saturated fat, n-6 PUFA, “Our anal ysis provides, for the first and trans fat based on country-specific time, a rigorous comparison of global dietary surveys, food availability data, CHD burdens attributable to insufficient and for trans fat, industry reports on n-6 PUFA versus higher saturated fat. fats/oils and packaged foods. The In 80% of nations, n-6 PUFA–attributeffects of dietary fats on CHD mortalable CHD burdens were at least twofold ity were derived from meta-analyses of prospective cohorts, and CHD mortality rates were derived from the 2010 Global Burden of Diseases Study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework. The researchers estimated insufficient n-6 PUFA consumption having been replaced by carbohydrate or saturated fat consumption was responsible for 711,800 CHD deaths per year, accounting for 10% of total global CHD mortality and for 187 CHD deaths per year per 1 million adults. The most absolute CHD deaths per year — 547 per 1 million adults — attributable to insufficient n-6 PUFA occurred in Eastern Europe, while Oceania had the highest proportion of n-6 PUFA–attributable CHD deaths. East Asia had both the fewest absolute — 74 per 1 million adults — and lowest proportion — 6.7% — of CHD deaths attributable to inadequate consumption of n-6 PUFA. Excess consumption of saturated fat as a replacement for n-6 PUFA caused an estimated 250,900 CHD deaths per year, accounting for 3.6% of CHD deaths and 66 CHD deaths per year per 1 million adults. T he researchers estimated that excess trans fat consumption caused 537,200 CHD deaths per year, representing 7.7% of global CHD mortality and 141 CHD deaths per year per 1 million adults. High-income nations generally had higher trans fat–attributable CHD mortality than lower-income nations. The highest trans fat–attributable absolute CHD mortality occurred in Egypt, with 1,120 deaths per year per 1 million adults. Canada, Pakistan, and the United States all had more than 475 deaths per year per 1 million adults because of excess consumption of trans fat. Such deaths accounted for more than 17% of corresponding national CHD mortality. Sub-Saharan Africa and the Caribbean had the lowest estimated trans fat–attributable CHD mortality. Additional findings of this study included mean global changes in dietary intakes of saturated fat, n-6 PUFA, and trans fat, and corresponding changes in CHD deaths occurring between 1990 and 2010. Specifically, global proportional CHD mortality attributable to insufficient n-6 PUFA and higher saturated fat consumption decreased by 9% and 21%, respectively. Such decreases occurred in concert with a 0.5% increase in consumption of n-6 PUFA and a 0.2% decrease in consumption of saturated fat. In high-income countries, trans fat consumption declined in parallel with policy strategies to reduce industrial trans fat production. In contrast, global proportional CHD deaths attributable to higher trans fat increased by 4% as global mean dietary intakes of trans fat increased by 0.1%. “Growing evidence indicates that lowering saturated fat provides convincing cardiovascular benefits only when replaced by PUFA, whereas cardiovascular benefits of n-6 PUFA are similar whether replacing saturated fat or total carbohydrates,” said Dr. Wang of the Harvard T.H. Chan School of Public Health, Boston. R ead the study in the Journal of the American Heart Association [doi:10.1161/ JAHA.115.002891]. CfA

Several recent studies in the USA, the UK and Australia have raised concern about a possible plateau or even reverse trend in coronary heart disease (CHD) mortality in younger populations. We aimed to assess the recent gender- and age-specific trends in CHD mortality among inhabitants aged 35-74 years from the three geographical areas covered by the French MONICA population registers.Registered events were fatal myocardial infarctions and coronary deaths selected after a thorough investigation by the physician who signed the death certificate, general practitioners and cardiologists, and by public and private hospitals for in-hospital deaths.From 2000 to 2007 age-standardized CHD mortality rates decreased significantly by 24% in men and 38% in women. In the age group 55-74, the estimated annual percentage change (EAPC) in mortality was -5.2 (95% confidence interval: -6.6 to -3.7; p 10(-4)) among men and -9.0 (-11.6 to -6.4; p 10(-4)) among women. In the 35-54 age group, the EAPC in mortality was -4.1 (-7.2 to -1.1; p 10(-2)) among men and -2.5 (-8.7 to 3.7; p = 0.43) among women. These trends remained similar when possible coronary deaths were also accounted for, except in young men where the decline was no longer significant.A clear decline in recent CHD mortality rates was observed among subjects above 54 years, but not among younger subjects, particularly in women. These results may be due to unfavourable trends in some risk factors in the latter age group and call for a strengthening of primary prevention.

ObjectiveResults of studies on fish consumption and CHD mortality are inconsistent. The present updated meta-analysis was conducted to investigate the up-to-date pooling effects.DesignA random-effects model was used to pool the risk estimates. Generalized least-squares regression and restricted cubic splines were used to assess the possible dose–response relationship. Subgroup analyses were conducted to examine the sources of heterogeneity.SettingPubMed and ISI Web of Science databases up to September 2010 were searched and secondary referencing qualified for inclusion in the study.SubjectsSeventeen cohorts with 315 812 participants and average follow-up period of 15·9 years were identified.ResultsCompared with the lowest fish intake (5 servings/week). The dose–response analysis indicated that every 15 g/d increment of fish intake decreased the risk of CHD mortality by 6 % (RR = 0·94; 95 % CI 0·90, 0·98). The method of dietary assessment, gender and energy adjustment affected the results remarkably.ConclusionsOur results indicate that either low (1 serving/week) or moderate fish consumption (2–4 servings/week) has a significantly beneficial effect on the prevention of CHD mortality. High fish consumption (>5 servings/week) possesses only a marginally protective effect on CHD mortality, possibly due to the limited studies included in this group.

Background: The aims of this study were to assess whether deprivation inequality at small area level in England is associated with coronary heart disease (CHD) mortality rates and to assess whether this provides evidence of an association between area-level and individual-level risk. Methods: Mortality rates for all wards in England were calculated using all CHD deaths between 2001 and 2006. Ward-level deprivation was measured using the Carstairs Index. Deprivation inequality within local authorities (LAs) was measured by the IQR of deprivation for wards within the LA. Relative deprivation for wards was measured as the modulus of the difference between deprivation for the ward and average deprivation for all neighbouring wards. Results: Deprivation inequality within LAs was positively associated with CHD mortality rates per 100 000 (eg, all men β; 95% CI=2.7; 1.1 to 4.3) after adjustment for absolute deprivation (p

Coronary heart disease (CHD) mortality is one of the major contributors to racial disparities in health in the United States (US). We examined spatial heterogeneity in black–white differences in CHD mortality across the US and assessed the contributions of poverty and segregation. We used county-level, age-adjusted CHD mortality rates for blacks and whites in the continental US between 1996 and 2006. Geographically weighted regression was employed to assess spatial heterogeneity. There was significant spatial heterogeneity in black–white differences in CHD mortality (median black–white difference 17.7 per 100,000, 25th–75th percentile (IQR): 4.0, 34.0, P value for spatial non-stationarity < 0.0001) before controlling for poverty and segregation. This heterogeneity was no longer present after accounting for county differences in race-specific poverty and segregation and interactions of these variables with race (median black–white difference −13.5 per 100,000, IQR: −41.3, 15.7, P value for spatial non-stationarity = 0.4346). The results demonstrate the importance of spatial heterogeneity in understanding and eliminating racial disparities in CHD mortality. Additional research to identify the individual and contextual factors that explain the local variations in racial disparities is warranted.

Background Coronary heart disease (CHD) mortality has steadily declined since the early 1970s in the Netherlands. However, in some Western countries the rate of decline in younger groups may be starting to plateau or even rise. Objective To examine trends in age-specific CHD mortality rates among Dutch adults from 1972 to 2007, with a particular focus on recent trends for the younger age groups Methods Data for all CHD deaths (1972e2007) in the Netherlands were grouped by year, sex, age. A joinpoint regression was fitted to each age-sex-group to detect points in time at which significant changes in the trends occur. For every time period, the linear slope of the trend, p value, observed number of deaths, CHD mortality rates and change in the CHD mortality rate were calculated. Results Between 1972 and 2007, the age-adjusted CHD mortality rates decreased overall by 76% in both men and women. In men (35e54 years), the change in CHD mortality rate in the period 1980e1993 was 0.53 but attenuated in period 1993e1999: 0.16. In women (35e54 years) the decline likewise attenuated to 0.44 in period 1979e1989: and 0.05 in period 1989e2000. After 1999e2000, CHD mortality rate further declined in both men (period 1999e2007: 0.46) and women (period 2000e2007: 0.38). Conclusions Evidence from several Western countries suggests that among young adults (

Background: Over the last two decades, mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) declined by about 30% in the European Union (EU). Design: We analyzed trends in CHD (X ICD codes: 120-125) and CVD (X ICD codes: 160-169) mortality in young adults (age 35-44 years) in the EU as a whole and in 12 selected European countries, over the period 1980-2007. Methods: Data were derived from the World Health Organization mortality database. With joinpoint regression analysis, we identified significant changes in trends and estimated average annual percent changes (AAPC). Results: CHD mortality rates at ages 35-44 years have decreased in both sexes since the 1980s for most countries, except for Russia (130/100,000 men and 24/100,000 women, in 2005-7). The lowest rates (around 9/100,000 men, 2/100,000 women) were in France, Italy and Sweden. In men, the steepest declines in mortality were in the Czech Republic (AAPC = -6.1%), the Netherlands (-5.2%), Poland (-4.5%), and England and Wales (-4.5%). Patterns were similar in women, though with appreciably lower rates. The AAPC in the EU was -3.3% for men (rate = 16.6/100,000 in 2005-7) and -2.1% for women (rate = 3.5/100,000). For CVD, Russian rates in 2005-7 were 40/100,000 men and 16/100,000 women, 5 to 10-fold higher than in most western European countries. The steepest declines were in the Czech Republic and Italy for men, in Sweden and the Czech Republic for women. The AAPC in the EU was -2.5% in both sexes, with steeper declines after the mid-late 1990s (rates = 6.4/100,000 men and 4.3/100,000 women in 2005-7). Conclusions: CHD and CVD mortality steadily declined in Europe, except in Russia, whose rates were 10 to 15-fold higher than those of France, Italy or Sweden. Hungary and Poland, and also Scotland, where CHD trends were less favourable than in other western European countries, also emerge as priorities for preventive interventions.