Coronary heart disease mortality trends in the Netherlands 1972-2007.

BACKGROUND: Coronary heart disease (CHD) mortality has steadily declined since the early 1970s in the Netherlands. However, in some Western countries the rate of decline in younger groups may be starting to plateau or even rise.
OBJECTIVE: To examine trends in age-specific CHD mortality rates among Dutch adults from 1972 to 2007, with a particular focus on recent trends for the younger age groups
METHODS: Data for all CHD deaths (1972-2007) in the Netherlands were grouped by year, sex, age. A joinpoint regression was fitted to each age-sex-group to detect points in time at which significant changes in the trends occur. For every time period, the linear slope of the trend, p value, observed number of deaths, CHD mortality rates and change in the CHD mortality rate were calculated.
RESULTS: Between 1972 and 2007, the age-adjusted CHD mortality rates decreased overall by 76% in both men and women. In men (35-54 years), the change in CHD mortality rate in the period 1980-1993 was -0.53 but attenuated in period 1993-1999: -0.16. In women (35-54 years) the decline likewise attenuated to -0.44 in period 1979-1989: and -0.05 in period 1989-2000. After 1999-2000, CHD mortality rate further declined in both men (period 1999-2007: -0.46) and women (period 2000-2007: -0.38).
CONCLUSIONS: Evidence from several Western countries suggests that among young adults (< 55 years), CHD mortality rates are levelling out. In this study, similar attenuation of the decline in CHD mortality among young adults in the Netherlands has been observed. Furthermore, this is the first study to observe a subsequent increase in the pace of decline after a period of flattening. In order to better explain these encouraging changes in CHD mortality rates, a detailed analysis of recent changes in cardiovascular risk factors and treatments is now urgently required.