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Of the world’s 50 most populous countries, population size and mortality data were available for 26 countries for at least 1 year from 1980: 19 had data for 1980, 22 for 1990, 15 for 2000 and 15 for 2010. Malaysia, Peru, South Africa and Turkey each had 1 year of data; Argentina, Brazil, China, Colombia, Mexico, Philippines, Uzbekistan and Venezuela had 2 years; Canada, Egypt, Germany, South Korea, Thailand and Ukraine had 3 years; and France, Italy, Japan, Poland, Russia, Spain, UK and USA had 4 years (see online supplementary eTable 1).

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Figure 1 shows the CHD and stroke mortality rates by sex, country and year for all available data. CHD mortality was higher than stroke mortality in men and women, except for some Asian countries. With few exceptions, mortality rates of CHD and stroke were considerably lower in 2000 and 2010 than in 1980 and 1990 in both sexes. The ranking of countries according to combined CHD and stroke mortality rates was broadly similar between men and women. In 1980, Ukraine, UK and Russia had the three highest combined CHD and stroke mortality rates for both sexes. In 2010, the corresponding top three countries were Russia, Ukraine and Poland.

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The 2010 CHD and stroke mortality rates by age and sex in five selected countries are shown in figure 2, and for all available countries and years in efigures 1 and 2. CHD and stroke mortality rates increased with age in men and women in all countries and years, with no apparent acceleration of mortality rates between particular age groups. For instance, there was no evidence of an effect of the female menopause. There was, however, variation between countries in the rate of increase in CHD mortality with ageing. For example, the increase in CHD mortality by age in Egypt, Russia and Ukraine was small compared with Canada, China, Germany, Italy, Poland, UK and USA. The rates of increase with ageing of the stroke mortality rates, in contrast, were similar between countries, and stoke mortality rates, by age, were much more similar between the sexes than were the CHD rates.

The effect of ageing on CHD mortality decreased with calendar time in most countries, notable exceptions being Mexico, Venezuela and Uzbekistan (figure 3 and see online supplementary eTable 3). This attenuation with calendar time was almost always greater in men than women, although most differences were small: China, Russia, Ukraine, UK and Uzbekistan had the greatest sex differential, always showing less of a positive effect in women, although Russia and Ukraine still had the greatest declines in the effect of ageing for women across all countries analysed. The corresponding results for stroke mortality were generally similar, although unlike for CHD, Russia and Ukraine showed virtually no change in the effect of ageing over the last 30 years on stroke mortality. Moreover, the attenuation of the effect of ageing on stroke mortality was similar between men and women.

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The distribution of men-to-women CHD and stroke mortality rate ratios across countries is shown in figure 4. CHD mortality rates were consistently higher in men than in women, but, the magnitude of the ratio varied by age. For example, in 2010, CHD mortality was, on average, about four times higher in men than in women aged 30-60 years and the ratio declined gradually to two times higher rates at ages 75-80 years. Stroke mortality rates were more constant with age, yet were about 1.5-2 times higher for men than for women up until age 70 years and older where the ratio was closer to unity.

The CHD-to-stroke mortality rate ratio differed between the sexes at all ages (figure 5). In men aged 40-64 years, CHD mortality was about twice as high as stroke mortality. The CHD-to-stroke mortality ratios were smaller at younger and older age, yet exceeded one in virtually all countries and years. In women, stroke mortality exceeded CHD mortality at almost all ages and in all years. However, ratios came closer to, or crossed, unity in the older age groups in all years except 2010.

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