Eur Heart J ：欧洲地区心脏病死亡率下降

英国研究人员近日报告说，上世纪80年代以来，欧洲心脏病死亡率普遍下降，一些国家的降幅甚至超过50％，但较年轻的心脏病患者死亡率降幅小于其他年龄段。

英国牛津大学的研究人员在英国新一期《欧洲心脏病学杂志》上报告说，他们调查了欧洲地区1980年至2009年心脏病死亡率的情况。结果发现，从国家来看，丹麦、荷兰、瑞典和英国的心脏病整体死亡率下降最多。但从年龄段来看，45岁以下较年轻的心脏病患者死亡率近年来变化不大。研究人员认为，该年龄段肥胖、糖尿病等其他风险因素的增加，抵消了吸烟率下降带来的益处。

研究人员指出，虽然从整体情况来看，欧洲大部分国家心脏病死亡率下降，但该地区没有一个国家的这一指数在所有年龄段都出现持续、稳定下降趋势。

研究人员同时强调，目前心脏病仍是欧洲人最主要的健康杀手，心脏病和中风每年在欧盟国家造成190万人死亡，约占全部死亡人数的40％，因此政策制定者和科研人员必须继续努力，通过有针对性的健康政策和科学研究，进一步减少心脏病对健康的威胁

Eur Heart J  doi: 10.1093/eurheartj/eht159

Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980–2009

Melanie Nichols, Nick Townsend, Peter Scarborough and Mike Rayner

Aims Recent decades have seen very large declines in coronary heart disease (CHD) mortality across most of Europe, partly due to declines in risk factors such as smoking. Cardiovascular diseases (predominantly CHD and stroke), remain, however, the main cause of death in most European countries, and many risk factors for CHD, particularly obesity, have been increasing substantially over the same period. It is hypothesized that observed reductions in CHD mortality have occurred largely within older age groups, and that rates in younger groups may be plateauing or increasing as the gains from reduced smoking rates are increasingly cancelled out by increasing rates of obesity and diabetes. The aim of this study was to examine sex-specific trends in CHD mortality between 1980 and 2009 in the European Union (EU) and compare trends between adult age groups.

Methods Sex-specific data from the WHO global mortality database were analysed using the joinpoint software to examine trends and significant changes in trends in age-standardized mortality rates. Specific age groups analysed were: under 45, 45–54, 55–64, and 65 years and over. The number and location of significant joinpoints for each country by sex and age group was determined (maximum of 3) using a log-linear model, and the annual percentage change within each segment calculated. Average annual percentage change overall (1980–2009) and separately for each decade were calculated with respect to the underlying joinpoint model.

Results Recent CHD rates are now less than half what they were in the early 1980s in many countries, in younger adult age groups as well as in the population overall. Trends in mortality rates vary markedly between EU countries, but less so between age groups and sexes within countries. Fifteen countries showed evidence of a recent plateauing of trends in at least one age group for men, as did 12 countries for women. This did not, however, appear to be any more common in younger age groups compared with older adults. There was little evidence to support the hypothesis that mortality rates have recently begun to plateau in younger age groups in the EU as a whole, although such plateaus and even a small number of increases in CHD mortality in younger subpopulations were observed in a minority of countries.

Conclusion There is limited evidence to support the hypothesis that CHD mortality rates in younger age groups in the member states of the EU have been more likely to plateau than in older age groups. There are, however, substantial and persistent inequalities between countries. It remains vitally important for the whole EU to monitor and work towards reducing preventable risk factors for CHD and other chronic conditions to promote wellbeing and equity across the region.