Coronary heart disease epidemics: not all the same.

Background: Coronary heart disease (CHD) was an important epidemic in many developed countries in the 20th century and there is concern because the epidemic has affected Eastern Europe, Russia and Central Asia and is starting to affect developing countries.

Methods: The epidemic curves of CHD mortality for 55 countries, which had reliable data and met other selection criteria, were examined using age-standardised death rates 35-74 years from the World Health Organization. Annual male mortality rates for individual countries from 1950 to 2003 were plotted and a table and a graph used to classify countries by magnitude, pattern and timing of its CHD epidemic.

Results: The natural history of CHD epidemics varies markedly among countries. Different CHD patterns are distinguishable including "rise and fall" (classic epidemic pattern), "rising" (first part of epidemic) and "flat" (no epidemic yet). Furthermore, epidemic peaks were higher in Anglo-Celtic countries first affected by the epidemic, and subsequent peaks were less, except for the recent extraordinary epidemics in Russia and Central Asian republics. There were considerable differences among some continental or regional geographical areas. Eastern European, South American and Asian countries have quite different epidemic characteristics, including shorter epidemic cycles.

Conclusions: It cannot be assumed that WHO regions or any other geographical regions will be useful when analysing CHD epidemics or deciding upon strategic policies to reduce CHD in individual countries. The needs for action that are urgent in some countries are less so in others, and even regional country groups can have quite different epidemic characteristics.