Changing mortality from ischaemic heart disease in Great Britain 1968-76.

The decline in death rates from ischaemic heart disease (IHD) (ICD 410-413) in the United States is now well documented. Over-the period 1963-75 the drop in age-specific mortality varied from 27 2O for those aged 35-44 to 19-30o for the over-85s.1 Concurrent with these changes have been reductions in the consumption of tobacco products, milk and cream, butter, eggs, and animal fats and oils and an increase in the use of vegetable fats and oils. In England and Wales no similar encouraging change in IHD mortality has been described. In the Royal College of Physicians' report2 annual death rates for IHD in men aged 35-44, 45-54, and 55-64 showed a pronounced increase from the period 1950-2 to 1973. There was, on the other hand, little change in the rates for women. Similar findings were presented for the Republic of Ireland, Northern Ireland, and Scotland, the latter two having substantially higher rates than England and Wales. A detailed analysis of mortality from heart disease in England and Wales for the years 1950-73'3 4has confirmed the general upward trend for men even after allowing for the possibility of an iatrogenic transfer of diagnosis from the rubrics for hypertension and myocardial insufficiency to that of IHD. The mortality trends for women are less clear. Clayton et al3 concluded that no change in death rates took place during the period 1950-73 in women aged 50 and over, but that there was a consistent increase for young women. The combination of IHD with other rubrics in this analysis has been questioned by Wald and Mann,; who believe that there was no justification for combining deaths from hypertension with those of IHD. The trends for IHD alone indicated an increase for all women up to age 64. We present mortality data for 1968-76 for England and Wales and for Scotland that suggest that IHD death rates for men stabilised in about 1972 and since then have started to decline. No similar decline was found for mortality in women.