The relationship of lifestyle to international trends in CHD.

Three components of lifestyle--nutrition, smoking and alcohol drinking patterns--have been related to rates of decline or increase of coronary heart disease (CHD) mortality in 27 countries during the past 10 to 25 years. In almost all of the countries with major falls or rises in CHD mortality, there are, respectively, corresponding decreases or increases in animal fat consumption, with reciprocal changes in the consumption of vegetable fats. Countries with moderate or small mortality declines show variable patterns of fat consumption. The prevalence of smoking is declining among men and remains unchanged or is increasing slightly among women in most countries, suggesting that differences in the rate of decline between countries or between the sexes are not related to an appreciable degree to differences in the change of smoking habits; however, the mortality changes in any individual country are most probably influenced by smoking. The consumption of alcoholic beverages increases almost everywhere and cannot be related quantitatively to the secular CHD mortality trends. These findings support in general the presently recommended courses of action for the prevention of premature CHD.