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Pharmacy Links

RATES OF HEART DISEASE IN DIFFERENT COUNTRIES

April 2, 2009

Countries vary enormously in the proportion of their populations with coronary heart disease. In 1986, Professor Hugh Tunstall-Pedoe of Dundee, Scotland, compared mortality rates from coronary heart disease in men aged forty to sixty-nine years from thirty countries. At the top of the list were Northern Ireland, Finland, and Scotland, with six hundred deaths per one hundred thousand men of that age range per year. England and Wales were next, followed by, in the middle, the United States, Norway, Canada, and Israel, with three hundred to four hundred deaths per one hundred thousand. Countries with much lower rates—around one hundred to two hundred deaths per one hundred thousand—were Italy, Yugoslavia, Greece, Spain, and France. Lowest of all, by far, was Japan, with a death rate of around fifty per one hundred thousand—less than one-tenth of the death rates of the three top countries.

The variations are not just between countries, but within them. Within lowland Scotland, coronary deaths are high in the west and low in the east—a twofold difference in populations living only forty or so miles apart. Districts within western Scotland vary by as much as twofold in their heart disease death rates.

Such regional and local variations in coronary disease have given the clues to its causes. One clue was given in the 1960s by the International Atherosclerosis Project, when investigators from fourteen countries in North, South, and Central America, the Philippines, Jamaica, South Africa, and Norway collected specimens of arteries from postmortem examinations of 22,509 people aged from ten to sixty-nine years.

They showed that atheroma was present in the arteries of all people, regardless of age, race, and geography. It was more common and more extensive as they aged. However, the severe form of the disease—in which there were raised plaques with roughened surfaces projecting into the bloodstream—was closely linked to death rates from heart attacks in the countries concerned. The environment was much more important than race or gender. The severity of the atheromatous changes was directly associated with average blood cholesterol levels in the various populations.