Diverging trends in cardiovascular morbidity and mortality in a low risk population

Abstract

Cardiovascular (CVD) disease morbidity and mortality are changing over the years, following changes in socioeconomic conditions and underlying risk factors. However, the trends of these changes differ among various populations. There is little data regarding these trends in low CVD risk populations. Tables of deaths by cause and age for the period 1956-2007 and tables of hospitalizations for the period 1979-2003 published by the National Statistical Service of Greece were used. Trends over time were determined using log-linear regression models. Age-adjusted all-cause mortality has declined steadily since 1964 in both sexes. CVD mortality initially increased until the late 1980s and subsequently decreased. An increase in mortality from stroke was seen until 1978, especially in men, followed by a decline. Mortality from coronary heart disease (CHD) increased initially, continued to increase for one decade more than stroke and started to decrease in 1989. However, only in women has CHD mortality returned below 1956 levels. As a result, deaths from CHD have surpassed those from stroke. Although the in-hospital fatality of acute myocardial infarction (AMI) has decreased by half between 1979 and 2003, deaths from AMI have decreased only slightly, as hospitalization and morbidity rates have increased during the same period. Although the various types of CVD share common risk factors, the trends of their respective mortality rates have differed significantly over the past five decades in the Greek population. This could partly be explained by the fact that risk factors do not equally contribute to CHD and stroke, and they might have not all been equally well controlled.