A Baffling Coronary Puzzle

WHO charts a global shift in fatalities

Heart disease, the No. 1 killer in industrialized countries, has been fought with research grants and take-care-of-yourself warnings for years. But with what success? To find out, experts at the World Health Organization in Geneva have been compiling statistics on one indicator, deaths from heart attacks, since 1968. The figures, from 28 countries for the decade ending in 1977, offer an intriguing--and baffling--picture of shifting patterns in fatal heart attacks.

Deaths rose dramatically in some countries while falling in others. In some, increases or decreases were registered only among men or women. In France, deaths rose for men but fell for women.

Because the statistics deal only with deaths, they are not necessarily an accurate gauge of the incidence of nonfatal heart attacks or of heart disease in general. Improved medical care may lower fatalities, even though the number of people suffering from heart attacks or other heart conditions may be on the rise.

The statistics, moreover, do not relate shifting heart attack patterns to changes in living styles. Doctors everywhere have been urging people to eat less saturated fat and cholesterol-rich food, slim down, seek treatment for high blood pressure, get more exercise and stop smoking.* In the U.S., where the message seems to be getting through, rates of fatal heart attacks among both men and women have been dropping by about 3% a year since 1968. Yet in Sweden, where antismoking and other risk-reduction campaigns have been vigorously pursued, death rates for both sexes have been rising. In Switzerland, where there has been a decline in heart attack deaths among women, smoking among women and consumption of animal fats are on the upswing. Says Dr. Zbynek Pisa, chief of WHO's department of cardiovascular diseases: "The statistics give us little or no clue in correlating heart disease with risk factors."

To resolve the questions raised by the figures, the organization is launching a more thorough study comparing heart attack incidence and death rates and behavior patterns in ten countries, including the Soviet Union and possibly China. But the answers will not be available soon: the study, says WHO, will take at least a decade. qed

* Labeling smoking "the single most important preventable cause of death and disease" in America, the U.S. Surgeon General last month called for a drive to cut the share of the adult population that still uses cigarettes from 33% to 25% or less by 1990.

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