Death rates from coronary heart disease have plunged over 30 years in Europe. But analysts in a study published June 25 in the European Heart Journal detected glimmers of a reversal in some countries within the European Union (EU).
Melanie Nichols, PhD, a research associate with the British Heart Foundation Health Promotion Research Group, and colleagues accessed the World Health Organization (WHO) global mortality database to study trends in cardiovascular disease between 1980 and 2009 across the EU. They calculated age-standardized coronary heart disease mortality rates by country, sex and age group (45 years and younger; 45-54 years; 55 to 64 years; and 65 years and older).
Most countries had significant decreases in death rates from coronary heart disease for both sexes and all age groups. The age-standardized mortality rates in 2005 to 2009 for many of the countries were half the rates from 1980 to 1984, and sometimes even better than half.
The overall median annualized percentage change was minus 2.7 for men and minus 2.4 for women over three decades. Nichols et al described the decreases as “stable or decelerating in the majority of countries” with similar rates of decline for the youngest and oldest groups.
But they also observed a great deal of variation among countries. Denmark, The Netherlands, Sweden, Malta and the U.K. experienced the steepest declines in mortality from coronary heart disease for both sexes. But men in several Eastern European countries saw only modest and statistically insignificant improvement and men in Romania posted a statistically significant bump up in mortality rates. Nichols et al also noted a significant increase in coronary heart disease mortality rates in younger age groups in Greece and Lithuania.
“The existing body of published evidence on this topic has provided very important evidence, in a number of individual countries in Europe and beyond, that despite overall very impressive reductions in CHD [coronary heart disease] mortality in recent decades, it is possible that the increasing prevalence of risk factors, such as diabetes and obesity, and plateaus in the prevalence of hypertension, are attenuating these reductions for younger populations,” they wrote. “While this is clearly true in some countries, our study has demonstrated that there is in fact substantial variation between EU countries in how these trends are playing out.”
They pointed out that the coverage and quality of data in the WHO database varied by country, and individual countries followed differing practices in ICD coding. Only 14 of the 26 countries included in the analysis had complete data for all 30 years.
They found little evidence that the downtrend in coronary heart disease mortality rates had sputtered out in younger age groups as a whole. But they voiced concern over signs of a plateau in a few countries which “would be an important advance warning of potentially very high future burden of CHD as the cohort ages.”