The treatment of coronary heart disease: an update. Part 2: Mortality trends and main causes of death in the Greek population.

The Seven Countries Study, carried out in the 1960s, showed a low cardiovascular disease (CVD) mortality in the Greek population. Since then, although the age-adjusted all-cause mortality has gradually and steadily decreased, CVD mortality has increased, mainly due to a rise in ischaemic heart disease (IHD) mortality, and, more specifically, myocardial infarction (MI). The number of MIs per 100,000 men aged 30-69 years increased from 195 in 1981 to 297 in 1988 and from 35 to 52 in women, respectively. Age-adjusted IHD mortality in men aged 45-74 years almost doubled from 1956 to 1978. The rate of increase slowed down for a decade and since 1990 it has declined slightly. In women, the age-adjusted IHD mortality increased, but to a lesser degree until 1990, and then it started to decline. Cerebrovascular mortality was higher than IHD mortality in women and equal to IHD mortality in men in the late 1950s and early 1960s, but it started to decrease in 1972 in men, and in 1973 in women. Cancer mortality is the second commonest cause of death in both genders. Age-adjusted cancer mortality (in those aged 45-74 years) increased slightly in men until 1979 and then remained stable. In women, it remained stable until 1991 and then started to decline. The eradication of malaria and rheumatic fever, the decrease in infectious diseases, the improvement of the medical care system and the rise of the population's socio-economic level achieved during the last five decades in Greece have reduced all-cause mortality. On the other hand, the changes in lifestyle (lack of physical exercise, new dietary habits) have resulted in a higher IHD mortality. However, this increase is less than would be expected, taking into account the rise in blood cholesterol levels and the high prevalence of smoking. The recent small decline in IHD mortality is probably attributable to better treatment of IHD rather than to preventive measures.