International mortality from heart disease: rates and trends

Mortality trends are described for heart disease, its main subgroup coronary heart disease (CHD), and total mortality for men and women 45-64 years of age from 1950 to 1985 in 27 countries. In contrast to the epidemic rise in mortality from CHD prior to the 1960s, the death rate is declining in most industrialized countries except in Eastern Europe where trends remain upward. Mortality from CHD was upwards in 18 countries in the 1970s and in only four countries in the 1980s. Peaks for CHD occurred earlier in women than men. With some exceptions, declines were greater for higher than lower rate countries. In many countries, CHD declines are accompanied by a corresponding downward change in total mortality, which suggests that the declines are real. Although in several countries there is substantial mortality from heart diseases other than CHD, generally there is good correspondence in trends between them over the 35-year period. There is also a trend toward less intercountry variability in death rates and proportionate mortality for CHD. But the North-South high-to-low gradient in Europe continues in 1985, and there remains at least a fourfold difference for men and an eightfold difference for women between the highest and lowest CHD rates. The male/female ratios of the rates, while narrowing in many countries, vary from 3:1 to 6:1 among the 27 countries.