Cardiovascular mortality in Korea: a country experiencing epidemiologic transition.

BACKGROUND: The pattern of morbidity and mortality of cardiovascular disease (CVD) changes with epidemiologic transition. An understanding of this pattern in rapidly developing countries might provide important clues for the understanding of the epidemiological trends in CVD mortality. The objective of this paper was to address the changing pattern of CVD mortality in Korea during the period 1984-1999, and to examine the significant changes in associated major risk factors for CVD over a similar period.
METHODS: For the purpose of this study, three main categories in CVD were reviewed: hypertensive heart disease, ischaemic heart disease, and cerebrovascular disease (stroke). The analyses of mortality were based on nationwide mortality data published by the National Statistical Office from 1984 to 1999. All the mortality rates were adjusted for age using the direct method. Changes in major CVD risk factors (blood pressure, cigarette smoking, serum total cholesterol and diet) were also reviewed during similar periods.
FINDINGS: During the 15-year period investigated, the age-adjusted mortality from CVD decreased markedly. It decreased by 57% in males (from 172.2 to 73.0/100,000) and 48% in females (from 135.5 to 70.2/100,000). The age-adjusted mortality from stroke decreased while the proportion of ischaemic strokes among total stroke deaths increased. The proportion increased about 5.2 times in men and 4.9 times in women. The age-adjusted mortality from hypertensive heart disease decreased markedly. It decreased by 92% in men (from 51.6 to 4.1/100,000) and 84% in women (from 34.1 to 5.3/100,000). Also the age-adjusted mortality from ischaemic heart disease increased significantly. In 1999, the rates for men and women were 11.9 and 7.5/100,000, respectively. These rates were 3.8 and 3.6 times higher than the rates in 1984 for men and women, respectively. The changes of CVD risk factors in Korea observed during a similar period were a decrease in hypertension prevalence, although still present at a high level, an increase in serum total cholesterol level and intake of total fat along with a high, although decreasing, prevalence of cigarette smoking.
INTERPRETATION: The mortality changes in Korea are consistent with the change that occurs during the transition from the age of receding pandemics to the age of degenerative and man-made diseases. This study has indicated that the change of CVD mortality was closely associated with the change in CVD risk factors. In order to avert the ongoing epidemic of CVD in developing countries, prevention and treatment of modifiable risk factors must become a high health priority.