title: Ageing, menopause, and ischaemic heart disease mortality in England, Wales, and the United States: modelling study of national mortality data.
abstract: OBJECTIVE
  To use changes in heart disease mortality rates with age to investigate the plausibility of attributing women's lower heart disease mortality than men to the protective effects of premenopausal sex hormones.
  
  
  METHODS
  Modelling study of longitudinal mortality data with models assuming (i) a linear association between mortality rates and age (absolute mortality) or (ii) a logarithmic association (proportional mortality). We fitted models to age and sex specific mortality rates in the census years 1950 to 2000 for three birth cohorts (1916-25, 1926-35, and 1936-45).
  
  
  METHODS
  UK Office for National Statistics and the US National Center for Health Statistics. Main outcome measure(s) Fit of models to data for England and Wales and for the US.
  
  
  RESULTS
  For England-Wales data, proportional increases in ischaemic heart disease mortality fitted the data better than absolute increases (improvement in deviance statistics: women, 58 logarithmic units; men, 37). We identified a deceleration in male mortality after age 45 years (decreasing from 30.3% to 5.2% per age-year, P = 0.042), although the corresponding difference in women was non-significant (P = 0.43, overall trend 7.9% per age-year, P<0.001). By contrast, female breast cancer mortality decelerated significantly after age 45 years (decreasing from 19.3% to 2.6% per age-year, P<0.001). We found similar results in US data.
  
  
  CONCLUSIONS
  Proportional age related changes in ischaemic heart disease mortality, suggesting a loss of reparative reserve, fit longitudinal mortality data from England, Wales, and the United States better than absolute age related changes in mortality. Acceleration in male heart disease mortality at younger ages could explain sex differences rather than any menopausal changes in women.
authors: Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. dvaidya1@jhmi.edu
authors: Dhananjay
authors: D
authors: Vaidya
authors: Diane M
authors: DM
authors: Becker
authors: Vera
authors: V
authors: Bittner
authors: Rasika A
authors: RA
authors: Mathias
authors: Pamela
authors: P
authors: Ouyang
mesh_terms: D017677:Age Distribution; D000368:Aged; D004739:England / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D017678:Sex Distribution; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014852:Wales / Q000453:epidemiology