Trends in mortality from coronary heart and cerebrovascular diseases in the Americas : 1970-2000

Objective: To describe trends in mortality from coronary heart disease (CHD) and cerebrovascular accidents (CVAs) over the period 1970 to 2000 in the Americas. Methods: Age standardised mortality rates were derived from the World Health Organization database and grouped according to the International classification of diseases, ninth revision. Joinpoint analysis was used to identify changes in trends. Results: In the USA and Canada, CHD mortality rates declined by about 60% in both sexes. In Latin America, falls in CHD mortality were observed for Argentina, Brazil, Chile, Cuba, and Puerto Rico. In 2000, mortality rates among men were highest in Venezuela (137.3/100 000) and lowest (apart from Ecuador) in Argentina (63.5/100 000). For women, the rates were highest in Cuba (79.4/100 000) and lowest in Argentina (26.5/100 000). For CVA mortality, a decline by about 60% was observed in the USA and Canada for both sexes. The falls were smaller (about -25% to -40% among men and -20% to -50% among women) in Puerto Rico, Argentina, Chile, and Costa Rica and only minor in Ecuador, Mexico, and Venezuela. Around 2000, CVA mortality in Latin America was highest in Brazil (85.5/100 000 among men and 61.7/100 000 among women) and lowest in Puerto Rico (29.3/100 000 among men and 24.1/100 000 among women). Conclusions: Recent falls in CHD and CVA were less favourable in Latin America than in the USA and Canada. This may reflect unfavourable changes in nutrition (including obesity), physical activity, and smoking in most Latin American countries, together with less effective control of hypertension and management of the diseases.