Coronary heart disease epidemics: not all the same

Area of Science:

• Epidemiology
• Cardiovascular Disease Research
• Public Health

Background:

• Coronary heart disease (CHD) posed a significant epidemic challenge in developed nations during the 20th century.
• Concerns exist regarding the growing impact of CHD on Eastern Europe, Russia, Central Asia, and developing countries.

Purpose of the Study:

• To analyze the variations in Coronary Heart Disease (CHD) epidemic curves across different countries.
• To classify countries based on the magnitude, pattern, and timing of their CHD epidemics.
• To inform the development of region-specific CHD reduction strategies.

Main Methods:

• Examined age-standardized CHD mortality rates (35-74 years) from the World Health Organization for 55 countries.
• Utilized data from 1950 to 2003, plotting annual male mortality rates.
• Classified countries by CHD epidemic magnitude, pattern (e.g., 'rise and fall,' 'rising,' 'flat'), and timing.

Main Results:

• Significant variations in the natural history of CHD epidemics were observed globally.
• Distinct epidemic patterns were identified, including 'rise and fall,' 'rising,' and 'flat' trajectories.
• Anglo-Celtic countries experienced higher initial epidemic peaks, with subsequent declines, contrasting with extraordinary recent epidemics in Russia and Central Asia. Notable differences were also found among Eastern European, South American, and Asian countries, often exhibiting shorter epidemic cycles.

Conclusions:

• WHO regions or other broad geographical groupings may not be suitable for analyzing CHD epidemics or formulating reduction policies.
• The urgency and characteristics of CHD epidemics differ significantly between countries, necessitating individualized strategic approaches.
• Tailored public health interventions are required, as regional country groups display diverse epidemic profiles.