title: Worldwide patterns of ischemic heart disease mortality from 1980 to 2010.
abstract: BACKGROUND
  The trends in the IHD mortality rates vary widely across countries, reflecting the heterogeneity in the variation of the exposure to the main risk factors and in the access to different management strategies among settings. We aimed to identify model-based patterns in the time trends in IHD mortality in 50 countries from the five continents, between 1980 and 2010.
  
  
  RESULTS
  Mixed models were used to identify time trends in age-standardized mortality rates (ASMR) (age group 35+years; world standard population), all including random terms for intercept, slope, quadratic and cubic. Model-based clustering was used to identify the patterns. We identified five main patterns of IHD mortality trends in the last three decades, similar for men and women. Pattern 1 had the highest ASMR and pattern 2 exhibited the most pronounced decrease in ASMR during the entire study period. Pattern 3 was characterized by an initial increase in ASMR, followed by a sharp decline. Countries in pattern 4 had the lowest ASMR throughout the study period. It was further divided into patterns 4a (consistent decrease in ASMR throughout the period of analysis) and 4b (less pronounced declines and highest rates observed mostly between 1996 and 2004). There was no correspondence between the geographic or economical grouping of the analyzed countries and the patterns found in this study.
  
  
  CONCLUSIONS
  Our study yielded a new framework for the description, interpretation and prediction of IHD mortality trends worldwide.
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal; Institute of Public Health, University of Porto (ISPUP), Portugal.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Gouvinhas
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal; Institute of Public Health, University of Porto (ISPUP), Portugal.
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal; Institute of Public Health, University of Porto (ISPUP), Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.affiliation: Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal; Institute of Public Health, University of Porto (ISPUP), Portugal. Electronic address: nlunet@med.up.pt.
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003324:Coronary Artery Disease / Q000401:mortality*; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality / Q000639:trends*; D017202:Myocardial Ischemia / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution
keywords: Cluster analysis; Epidemiology; Mortality; Myocardial ischemia