title: Coronary heart disease and cerebrovascular disease mortality in young adults: recent trends in Europe.
abstract: BACKGROUND
  Over the last two decades, mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) declined by about 30% in the European Union (EU).
  
  
  METHODS
  We analyzed trends in CHD (X ICD codes: I20-I25) and CVD (X ICD codes: I60-I69) mortality in young adults (age 35-44 years) in the EU as a whole and in 12 selected European countries, over the period 1980-2007.
  
  
  METHODS
  Data were derived from the World Health Organization mortality database. With joinpoint regression analysis, we identified significant changes in trends and estimated average annual percent changes (AAPC).
  
  
  RESULTS
  CHD mortality rates at ages 35-44 years have decreased in both sexes since the 1980s for most countries, except for Russia (130/100,000 men and 24/100,000 women, in 2005-7). The lowest rates (around 9/100,000 men, 2/100,000 women) were in France, Italy and Sweden. In men, the steepest declines in mortality were in the Czech Republic (AAPC = -6.1%), the Netherlands (-5.2%), Poland (-4.5%), and England and Wales (-4.5%). Patterns were similar in women, though with appreciably lower rates. The AAPC in the EU was -3.3% for men (rate = 16.6/100,000 in 2005-7) and -2.1% for women (rate = 3.5/100,000). For CVD, Russian rates in 2005-7 were 40/100,000 men and 16/100,000 women, 5 to 10-fold higher than in most western European countries. The steepest declines were in the Czech Republic and Italy for men, in Sweden and the Czech Republic for women. The AAPC in the EU was -2.5% in both sexes, with steeper declines after the mid-late 1990s (rates = 6.4/100,000 men and 4.3/100,000 women in 2005-7).
  
  
  CONCLUSIONS
  CHD and CVD mortality steadily declined in Europe, except in Russia, whose rates were 10 to 15-fold higher than those of France, Italy or Sweden. Hungary and Poland, and also Scotland, where CHD trends were less favourable than in other western European countries, also emerge as priorities for preventive interventions.
authors.affiliation: Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri', Milan, Italy. paola.bertuccio@marionegri.it
authors.forename: Paola
authors.initials: P
authors.lastname: Bertuccio
authors.forename: Fabio
authors.initials: F
authors.lastname: Levi
authors.forename: Francesca
authors.initials: F
authors.lastname: Lucchini
authors.forename: Liliane
authors.initials: L
authors.lastname: Chatenoud
authors.forename: Cristina
authors.initials: C
authors.lastname: Bosetti
authors.forename: Eva
authors.initials: E
authors.lastname: Negri
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D002561:Cerebrovascular Disorders / Q000401:mortality*; D003327:Coronary Disease / Q000401:mortality*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D009010:Monte Carlo Method; D009026:Mortality / Q000639:trends; D013997:Time Factors; D014944:World Health Organization