BACKGROUND The substantial decline in cardiovascular-disease (CVD) mortality in high-income countries has underpinned their increasing longevity over the past half-century. However, recent evidence suggests this long-term decline may have stagnated, and even reversed in younger populations. We assess recent CVD-mortality trends in high-income populations and discuss the findings in relation to trends in risk factors. METHODS We used vital statistics since 2000 for 23 high-income countries published in the World Health Organization Mortality Database. Age-standardized CVD death rates by sex for all ages, and at ages 35-74 years, were calculated and smoothed using LOWESS regression. Findings were contrasted with the Global Burden of Disease (GBD) Study. RESULTS The rate of decline in CVD mortality has slowed considerably in most countries in recent years for both males and females, particularly at ages 35-74 years. Based on the latest year of data, the decline in the CVD-mortality rate at ages 35-74 years was <2% (about half the annual average since 2000) for at least one sex in more than half the countries. In North America (US males and females, Canada females), the CVD-mortality rate even increased in the most recent year. The GBD Study estimates, after correcting for misdiagnoses, suggest an even more alarming reversal, with CVD death rates rising in seven countries for at least one sex in 2017. The rate of decline and initial level of CVD mortality appear largely unrelated. CONCLUSIONS A significant slowdown in CVD-mortality decline is now apparent across high-income countries with diverse epidemiological environments. High and increasing obesity levels, limited potential future gains from further reducing already low smoking prevalence, especially in English-speaking countries, and persistent inequalities in mortality risk pose significant challenges for public policy to promote better cardiovascular health.

中文翻译：

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高收入国家的心血管疾病死亡率长期下降了吗？来自国家生命统计的证据。

背景技术在高收入国家，心血管疾病（CVD）死亡率的大幅下降支撑了它们在过去半个世纪中不断增长的寿命。但是，最近的证据表明，这种长期下降可能已经停滞，甚至在年轻人口中得到了扭转。我们评估高收入人群的近期CVD死亡率趋势，并讨论与危险因素趋势相关的发现。方法自2000年以来，我们使用了世界卫生组织死亡率数据库中发布的23个高收入国家的生命统计数据。计算所有年龄段（35-74岁）的按性别划分的年龄标准化CVD死亡率，并使用LOWESS回归进行平滑处理。研究结果与全球疾病负担（GBD）研究形成对比。结果近年来，大多数国家的男性和女性，尤其是35-74岁年龄段的CVD死亡率下降速度已大大减慢。根据最近一年的数据，在超过一半的国家中，至少有一种性别的35-74岁年龄段的CVD死亡率下降幅度小于2％（大约是2000年以来年平均水平的一半）。在北美（美国的男性和女性，加拿大的女性），CVD死亡率在最近的一年甚至有所上升。GBD研究估计，在纠正误诊后，建议进行更令人震惊的逆转，2017年有至少七个性别的7个国家的CVD死亡率上升。CVD的下降率与初始死亡率水平似乎基本无关。结论在流行病学环境各异的高收入国家中，CVD死亡率下降的速度显着放缓。肥胖水平高且不断上升，通过进一步降低已经很低的吸烟率（特别是在英语国家），未来潜在的收益有限，并且持续存在的死亡风险不平等给促进改善心血管健康的公共政策提出了严峻挑战。