Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update. ACTA ACUST UNITED AC. 2009;16:333-350. [PMID: 19369880 DOI: 10.1097/hjr.0b013e328325d67d]

Income and heart disease mortality trends in Sao Paulo, Brazil, 1996 to 2010

BACKGROUND

Reductions in heart disease mortality rates are variable according to socioeconomic status.

METHODS

We performed a time trend analysis of all heart diseases (all circulatory diseases, except rheumatic, cerebrovascular, and aortic diseases) comparing three different household income levels (high, middle, and low) in the city of Sao Paulo from 1996 to 2010.

RESULTS

A total of 197,770 deaths were attributed to heart diseases; 62% of them were due to coronary diseases. The rate of death due to heart diseases declined for the city as a whole. The annual percent change (APC) and 95% confidence intervals for men living in the high, middle and low income areas were -4.1 (-4.5 to -3.8), -3.0 (-3.5 to -2.6), and -2.5 (-2.8 to -2.1), respectively. The decline in death rate was greatest among men in the wealthiest area. The trend rates of women living in the high-income area had one joinpoint; APC was -4.4 (-4.8 to -3.9) from 1996-2005 and -2.6 (-3.8 to -1.4) from 2005-2010. Middle and low income areas had an APC of -3.6 (-4.1 to -3.1) and -3.0 (-3.2 to -2.7) from 1996-2010, respectively. During the last 5years of observation, there was a gradient of the decline of the risk of death, faster for people living in the wealthiest area and slower for people living in the more deprived neighborhoods.

CONCLUSION

Reduction in deaths due to heart diseases is greatest for men and women living in the wealthiest neighborhoods.

Trends in mortality from myocardial infarction. A comparative study between Spain and the United States: 1990-2006

INTRODUCTION AND OBJECTIVES

Mortality from myocardial infarction is declining in high income countries, but the magnitude of this decline could differ between countries. We sought to compare the mortality trends from myocardial infarction between Spain and the United States.

METHODS

This was an observational retrospective study. Crude data were obtained from public databases. Standardized mortality rates were calculated for the last 17 years available for both countries (1990 to 2006), and stratified by age and sex. Joinpoint regression analysis was used for the trends analysis and projections.

RESULTS

There has been a steady decline in mortality from myocardial infarction in both countries from 1990 to 2006. However, the magnitude of this decline was greater in the United States (relative reductions in men: 42.7% [Spain] and 59.7% [United States], and in women: 40% [Spain] and 57.4% [United States]). The estimated annual percentages of decline in mortality were greater in the United States (men: -10.7%, women: -5.1%) than in Spain (men: -1.9%, women: -5.1%). Projections for 2012 suggest that the mortality from myocardial infarction will be lower in men in the United States (53.33/100,000) than in Spain (81.52/100,000), while for women it will be equal (32.56/100,000 in the United States and 33.56/100,000 in Spain).

CONCLUSIONS

The decline in mortality from myocardial infarction has been more pronounced in the United States than in Spain, and projections for upcoming years suggest in the United States it will evolve to rates below those expected in Spain for men and equal rates for women.

Gender- and age-specific trends in coronary heart disease mortality in France from 2000 to 2007: results from the MONICA registers

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Serum apolipoproteins in relation to intakes of fish in population of Arkhangelsk County

Background

Diets rich in omega-3 fatty acids and low in saturated fat were found beneficially associated with blood lipids and cardio-vascular health. Lean reindeer meet and local cold water white-fish species high in omega-3 are among the main sources of nutrients in the rural area of the Nenets Autonomous Okrug (NAO) in Russia and are not normally consumed by the urban population from the same region. The aims of the study were firstly, to compare serum lipid profiles of residents of urban (Arkhangelsk city) and rural (NAO) regions of Arkhangelsk County, and secondly, to investigate the effects of fish consumption on the predictor of cardiovascular events apolipoprotein (Apo) B/ApoA-I ratio in these populations.

Methods

A cross-sectional study conducted in Arkhangelsk County, Russia. Sample size of 249 adults: 132 subjects from Arkhangelsk city, aged 21–70 and 117 subject (87% Ethnic Nenets) from NAO, aged 18–69.

Results

We observed more favorable lipid levels in NAO compared to Arkhangelsk participants. Age-adjusted geometric means of ApoB/ApoA-I ratio were 1.02 and 0.98 in men and women from Arkhangelsk; 0.84 and 0.91 in men and women from NAO respectively. Age and consumption of animal fat were positively associated with ApoB/ApoA-I ratio in women (pooled samples from Arkhangelsk and NAO). Body mass index and low levels of physical activity were positively associated with ApoB/ApoA-I ratio in men (pooled samples from Arkhangelsk and NAO). Reported oily fish consumption was not significantly correlated with ApoB/ApoA-I ratio.

Conclusion

The population sample from rural NAO, consisting largely of the indigenous Arctic population Nenets with healthier dietary sources, had a relatively less atherogenic lipid profile compared to the urban Arkhangelsk group. Fish consumption had no effect on apolipoproteins profile.