Heart disease: which countries have the highest and lowest rates?

17 Jul

by Carolyn Thomas  @HeartSisters

Prepare to scratch your head in confusion as we consider the subject of geography for a moment.

In the U.K., the Brits’ high daily consumption of saturated and trans fats – chief suspects among risk factors for heart disease – is actually topped by those living in Germany, Belgium and France. Yet these three salami-eating countries boast fewer heart disease deaths than the U.K., according to the British Heart Foundation.

Even more confusing are the people of France. Although the French smoke more, eat more fat, and consume only slightly more fruit and vegetables than the British do, the French have the lowest heart death rate in the European Union – only about one-quarter of the British rate. This is the notorious French Paradox, which epidemiologists have puzzled over for decades.

Although French hearts appear to be the healthiest and best preserved in Europe, they are certainly among the worst on the risk factors of diet and smoking.

The Spaniards, Finns, Italians, and Portuguese all eat less harmful fat and consume more fruit and vegetables than the French – yet die in greater numbers from heart disease.

How can this be? 

According to the United Nations, in their report called UN Chronicle: The Atlas of Heart Disease & Stroke, Japan has one of the lowest rates of coronary heart disease in the world, but the Japanese were found to have a gradually increasing risk after moving to North America, eventually approaching that of those people born there. This sounds to me that lifestyle changes resulting from this move (↓ diet, ↓ exercise, ↑ stress) must have some influence on heart disease rates.

But why don’t the same heart disease risk factors seem to affect those Gauloises-smoking, double-cream brie and baguette-eating French?

Meanwhile, the highest rate of heart disease on the planet fluctuates a bit from year to year, but the annual winners seem to rotate around Eastern European populations in Ukraine, Bulgaria, Russia and Latvia.

Those Ukrainians, with a whopping 891 heart attacks per 100,000 population, are hard to beat on dietary risk factors alone.  I grew up here in a Ukrainian family, where our basic food groups were sour cream, bacon and butter. We considered dill pickles to be a vegetable dish in our house. And yet my own Baba lived well into her 90s, outlived three husbands, and was doing her own gardening and canning until almost the very end of her life. In that respect, she was behaving more like a French woman!

Researchers at Harvard University’s School of Public Health have come up with one theory about these confusing heart attack rates in their report called The Nutrition Source: Low-Fat Diet Not A Cure-All.

Here in Canada, when it comes to our likelihood of suffering a heart attack, the geography of our country also plays a role – along with our income.

New data from the Canadian Institute for Health Information show that the rate of heart attacks in Canada’s lowest-income neighborhoods was 255 per 100,000 population, compared to 186 per 100,000 in the most affluent ones. That’s a significant 37% difference.

The CIHI report released in May, called Health Indicators 2010, shows that heart attack rates here are actually doubled between some provinces, ranging from just 169 per 100,000 population here on the Pacific coast in British Columbia, to 347 per 100,000 far away on Canada’s Atlantic coast in Newfoundland and Labrador.

Dr. Indra Pulcins, director of indicators and performance measurement at CIHI, explains:

“Important gaps in heart health still exist between socio-economic groups, as well as between geographic regions in Canada. There are a lot of factors that come into play. But one thing we do know is that where there is variation, there is potential for improvement.”

The average age of heart attack sufferers in Canada is 71. Just over 35% of heart patients here are women, yet our outcomes are worse than male heart patients. Over half of all heart attack deaths occur in women.

The most surprising evidence from CIHI suggests that where you live has the most significant impact on heart attack rates, followed by neighbourhood income; these factors were more impactful than cardiac risk factors cited traditionally –  like diet and exercise.

The good news, according to the report, is that regardless of a person’s income or place of residence, both the care they received and their treatment outcomes were similar no matter where in Canada they lived.

Q: How critical are lifestyle choices to heart health?


    This article was #3 on the Top 10 Most-Read Posts here on Heart Sisters for 2013.

    See this ranked list of coronary heart disease death rate by country determined by WHO, World Bank, UNESCO, CIA and individual country databases for global health and causes of death (2011).


57 Responses to “Heart disease: which countries have the highest and lowest rates?”

  1. Sonya February 24, 2019 at 3:24 pm #

    My grandma was born in Siberia in 1903, she died 2008 two weeks short of 106, lived in her house until age 100 and had her vegetable garden. She outlived two husbands and her two children.


  2. Shiem March 4, 2017 at 10:37 pm #

    Natural olive oil, garlic, herb, no msg, pasta i think that key word. Eat naturally…


  3. Dprang March 5, 2015 at 10:06 am #

    This is good article. My take is the quality of food and the source of food.
    France is the most vocal about staying with no GMO seeds allowed and the EU supports the ban and labelling. In North America, people survive heart problems using pharma drugs. Affluence ensures better food source and quality as well as assessing medicine in all its wonder. I am at risk mostly due to years of eating poorly and yo-yo dieting. However, 6 years ago, I completely changed my diet, much like the French and take NO pharma drugs. It is costly, but well worth it. Great thing, my weight is and remains a non issue….


  4. phil baughen August 10, 2014 at 7:19 pm #

    the real reason for heart disease is cereales and sugars, countries high in saturated fats and lower sugar and cereal based foods have lower percentage of heart disease, nutrition in the west has been wrong for 50 years, the newest studies which include múltiple universities from across the globe including Oxford and Cambridge found no evidence saturated fat contributes to heart disease, all thats left is carbs lol

    Liked by 1 person

  5. Anon July 25, 2014 at 12:12 pm #

    NOTE: This reader’s comment was removed because it was a commercial plug for a product she was selling.


  6. Best Tip June 30, 2014 at 2:29 am #

    Which ever the country may be having high or low rates in cardiac disease, let us take the responsibility of spreading awareness. This might help few people to know much better and to be cautious.

    From my side I want to suggest Dr Enas A Enas, pioneering researcher, cardiologist and author, has a revolutionary healing plan for who are suffering with cardiac diseases – essential medicines, sensible and simple eating approach and life style advice. You will become healthier and reduce your risk for future attacks by 90% and live a long and rewarding life! And this will happen quickly — so fast that you will reduce your risks in just 90 days!


    • Carolyn Thomas June 30, 2014 at 5:46 am #

      If Dr. Enas is so concerned about spreading awareness, why is his “revolutionary plan” available only to those who send him money for his book or DVD?

      Liked by 1 person

  7. DURIANRIDER November 4, 2013 at 7:11 am #




    • Ann November 4, 2013 at 8:26 pm #

      Italy has far lower mortality for heart disease than most other countries as well, it’s actually in the top 20! Look up the data. They eat tons of fat in their meatballs and cheese loaded lasagna, butter, pasta, deserts, and yes, plenty of veggies, garlic and onions, too, but still none of them are only vegetable or plant eaters only. Spain and Portugal also in the best 20 and we all know what they eat. Plant eating only may not explain this puzzle at all.


  8. Physician List February 11, 2012 at 4:50 am #

    This is really helpful. I have read as well the other article in this website about how it really feels to have heart attack and I find myself really taking down notes; this is because I don’t want to lose a loved one because of a heart attack. Thank you so much for sharing.


  9. Jlaie November 28, 2011 at 2:19 pm #

    Spain is one of the six tobacco users in the world. French do not use nearly as much tobacco as other countries. Heart disease is a combination of diet and exposure to environmental chemicals. Chemicals are absorbed in the body in others ways besides our mouth.


    • Carolyn Thomas November 28, 2011 at 3:28 pm #

      Jlaie, you are misinformed. According to 2009 stats from the World Health Organization, smoking rates for those aged 15 and up are similar in both Spain and France (Spain: 29% and France 27.1%). And heart disease is linked to a number of factors, including but certainly not limited to diet and environmental factors.


    • Eric Brandon May 1, 2013 at 8:55 am #

      While being unfortunate enough to be locked up in federal prison for over 15 years I did my own study. 99% of everybody standing in the diabetic line every morning were overweight and inactive. And once diabetes set in all kinds of health problems seem to follow. The people who were out on the track walking, running, playing sports or on the weight pile most everyday seem to stay healthy even if they had poor eating habits.

      I did lose a friend to lung cancer who was very active but smoked about 3 packs a day. Also, as I watch my own relatives enter their golden years there is no doubt the ones who smoke have far more health problems then the ones that don’t or didn’t.


      • Carolyn Thomas May 1, 2013 at 12:53 pm #

        Hi Eric – sounds like you had your own observational research study going on there for 15 years…


        • Eric Brandon May 1, 2013 at 2:04 pm #

          Yeah, Carolyn, I’m convinced that the two most important ways to take care of your health is don’t smoke and keep moving.


          • Carolyn Thomas May 1, 2013 at 4:09 pm #

            I think you’re 100% right, Eric. No guarantee of course (there are always some elderly sedentary chain-smokers out there who defy predictions!) but generally speaking, I think the human body was built to move, not sit. And lots of evidence suggesting exercise is even superior to certain common medical procedures – example here of Dr. Rainer Hambrecht’s research on cardiac stents vs biking.


            • Eric Brandon May 2, 2013 at 9:08 am #

              Yeah, there’s definitely no guarantee. We all know someone who chain smokes non filters and lives healthy to a hundred then there’s people who die from second hand smoke. Heredity plays the biggest role.

              Liked by 1 person

      • Travis Ford June 6, 2013 at 4:20 pm #

        Eric I also had the pleasure of being in the BOP… when I went in I was overweight and had high blood pressure and was in the pill line at 40 years old. But I walked and exercised my way right out of that line so I agree whole heartedly, pardon the pun with your observations, because we both know the food wasn’t the least bit healthy in there.

        Sadly now that I’m out I have regained weight and become lethargic again and what happens ?? High blood pressure returns. So I would say I’m quite the case study for what exercise can do.


        • ladybloggerist October 1, 2015 at 7:41 am #

          Overall it is carrying extra weight which increases the likelihood of diabetes. How did we get overweight? Simple, we eat foods likely to add weight at alarming rates (junk, highly processed, nutrient poor with added chemicals). We are busy with stressful lives and in a car culture leading to low or no exercise. It pains me to see a family of overweight people at grocery stores. A look in their food buggy tells the story. Having said that, it is shameful how in the 70’s suddenly we went from whole foods to junk and processed foods, and the food and chemical companies have thrived to giants that control almost all aspects of food. I blame these giant corporations!


      • iskywalker June 7, 2013 at 7:53 am #

        When I lived in France, everyone that I knew smoke weed and tobacco a lot, eat lots of fat, don’t exercise, drink vino everyday. And they are very happy.


      • Albert Jennings July 15, 2018 at 1:18 pm #

        Don’t dismiss the importance of diet in preventing diabetes. The reason why physically active people seem to have lower incidents of diabetes is because exercise helps regulate your blood sugar. There are probably some other factors involved in your observations.


    • iskywalker June 7, 2013 at 7:45 am #

      Lol, have you ever been to France or Spain? I have several times and had lived there too. They both smoke like chimney at least everyone that I know, they eat fat, lots of French fries, salami, raw red ham, fried fat cube.


  10. Tenacious T September 19, 2011 at 7:06 pm #

    I ate a steak or cheeseburger almost every day of my life until I had a heart attack at 42. I am a hard core vegan now, and don’t even cook with olive oil. I feel ten years younger, my skin looks better and I hope/pray I will live to see my kids grow up now. I am doing this because I am trying to get all that nasty plaque out of my arteries. We shall see.


    • Robert Brink January 15, 2012 at 1:55 pm #

      Tenacious T, I will wager that you ate a lot of French fries and onion rings along with those steaks and cheeseburgers. These are fried in oils containing deadly trans-fats that cause inflammation and clog our arteries. You also probably drank a lot of soda pop and ate white bread, pasta and perhaps rice, and a lot of packaged foods that contain high-fructose corn syrup and vegetable oils that have been chemically treated, all of which also clog your arteries and cause inflammation. The steaks and cheeseburgers, except for the buns, contained health saturated fats and were not the cause of your heart attack.

      Liked by 1 person

      • John Q May 21, 2012 at 9:15 pm #

        That was beautifully put. Carbs and bad oils are the cause. Not the steaks, now excuse me while I finish off my last half pound of New York strip. 😉

        You forgot to mention that his Veganism is going to cause nothing but harm, however. 🙂


        • Noreen June 11, 2012 at 8:20 pm #

          Robert and John – you should both watch “Forks Over Knives” – it’s fascinating in terms of rates of disease of those who eat red meat vs. those who do not. It’s better to not eat red meat —


        • Ignorance won´t make you free March 16, 2013 at 10:40 am #

          As traditional rural Chinese and Japanese vegan diets, those people lives well into their hundreds with virtually no cancer, heart disease, diabetes… when those same people moved to another western country and took their eating habits, their mortality rates were the same as the locals. You might have to explain why you make such claim like “veganism is harmful” maybe what you mean is that it is unconvenient for you. I have been a vegan for 30 years and my doctors are impressed each time I take a blood test.


      • Morgan July 27, 2012 at 3:09 am #

        That’s nuts. Carbs and sugars cause heart attacks? I guess that’s what is literally clogging them, right? It couldn’t be all the gobbly fat and lard?
        If a meat based or meat centric diet is so darn good for you, answer me this.. How come there are no atkins/paleo athletes? Huh? I can promise you, if there are some that claim to be such, they have abso. no energy and are at the bottom of their game. Carbs and sugars = energy, people. Every single cell in the body runs on glycogen (sugar!)

        Diabetes is caused by fat clogging cells so that the sugar can’t enter the cell and it builds up in the body.

        Atkins was in horrible health when he died, and regardless of the skewed news reporting, he was in bad condition and had major heart disease. There are several others, too.. Look up durianrider on youtube. He’s got it.


        • Eric August 11, 2012 at 9:04 am #

          Morgan, you should do a bit more unbiased research. Check out Gary Taubes, Dr Robert Lustig, Dr Terry Wahl. History, science and clinical trials show saturated fats is healthy. Sugar is toxic followed by high carb refined grains. Meat and leafy veg diet is best for health.


      • Eric Brandon May 17, 2013 at 11:52 am #

        Sott.net has a good article to back this up.


    • Barry Foster March 30, 2013 at 9:39 am #

      has your change in diet helped you with your heart?


  11. Graham July 13, 2011 at 7:30 am #

    I agree with Ronny. The results are only puzzling because we are using the wrong lens. If we looked at sugar/refined carb intake, the rank order wouldn’t be surprising.


    • Ava February 16, 2012 at 2:24 pm #

      As matter of fact they eat a lot of bread and potato in the Eatern Europe, specially in Ukraine and Russia. In the past it was difficult to get anything else, so it was bread for breakfast, lunch and dinner eaten with soup, salami, bacon.


  12. Ronny October 24, 2010 at 7:57 am #

    I think you should be careful of what you consider “harmful fats”. The reason the French have such low rates of heart disease is because they eat saturated fats along with produce and wine. I do not know why the Spanish or Fins have more heart disease, but I do know that humans have been eating saturated fats for thousands of years without a problem.

    So, it is the hydrogenated oils, refined sugars, exercise levels, stress, and cigarettes we should be considering when we look at heart disease statistics


  13. Michael Anchors MD PhD August 10, 2010 at 11:12 am #

    Malcolm Kendrick is one among many who have exposed the fact that high cholesterol has nothing to do with heart attacks, and the statin drugs are ineffective. I should know. I have a PhD in biochemistry, helped develop Mevacor back in the eighties, took Mevacor for twenty years and still suffered a heart attack at age 55. My only risk factors were the real ones: stress and social isolation. Read Malcolm’s book, The Great Cholesterol Con, or Graveline’s work, The Statin Damage Crisis, or read Am. J. Clin. Nutr. 2009;10.3945/ajcn.2009.27725 or any similar papers. Or read the fine print in the statin ads where it says statins “are not indicated to prevent heart attacks, heart disease or strokes.”

    Read anything, instead of just listening to “what everyone says” or to practicing doctors who don’t read. Shame on them.


    • Dan March 18, 2011 at 10:03 am #

      Michael Anchors, you hit the nail right on the head, and drove it all the way home. It’s simply amazing that so many people don’t think for themselves or do their own research. Once you start looking at how the human body works, it becomes obvious that excess carbohydrate intake is to blame. I have not found one viable human study that shows otherwise.


      • Matt Stone December 9, 2011 at 2:02 pm #

        Yes Dan, this ties in amazingly well with the article above. I mean, Japan obviously has the lowest rate of heart disease of the countries listed because they consume the fewest carbohydrates by percentage of calories! Naht!!!

        If you came to this conclusion from “looking at how the human body works,” I would recommend a blindfold, glasses, anything other than the methods you’ve employed thus far. Heart disease isn’t caused by one of the 3 macronutrients. It amazes me that human intellect can’t seem to get past this major barrier.


  14. lidia July 18, 2010 at 8:56 am #

    Hi Carolyn, I found this very interesting. I read an article by Dr. Malcolm Kendrick (I hope I got his name right) – his research showed that when countries are suffering from political unrest, unemployment or from natural disasters, the rate of MI’s increases, which could explain Eastern Europe having such a tough time through unemployment and poverty. To my knowledge, the French, Germans and Belgians enjoy fairly comfortable lives, they are well cared for with a good system of health care and pensions.

    In my opinion, stress plays a huge part, more then diet or smoking.

    Maybe I should move across the channel to France?


  15. grow family grow July 17, 2010 at 7:05 am #

    I had a cardiac arrest at 28. An electrical storm messed up my heart, not cholesterol, but it was above normal. I changed my diet, took Niaspan, and my overall cholesterol levels went down. Not to normal, but down. My ratio of good to bad cholesterol was good.

    Ten years later, after coming off the Niaspan for my first pregnancy and then having my daughter, my cholesterol surprised me with normal levels. I have to assume this was impacted by a hormonal shift; my stress level didn’t go down and my diet/exercise routine degraded to accommodate my persistent morning sickness and my out of control heart rate.


    • Mark Pomeroy September 26, 2011 at 2:57 am #

      Regarding the French paradox, it could be something genetic. I think that if you looked at the French metabolism or the structure of their hearts, there is some advantage they have that most humans don’t. They already know that some people’s body stop producing cholesterol when cholesterol is consumed. Others keep right on, whether the diet is high in transfats or no. So we do have inherent physiological differences. Hmmmmmm . . . .


      • Frank Willis September 28, 2011 at 8:09 am #

        The answer is simple; the French consume lots of red wines, expecially (according to UCLA researchers) the Pinot Noir, Shiraz, and Cabernet Sauvignon.
        Frank Willis


      • frypan100 November 4, 2011 at 12:48 pm #

        I am 54, female, had bypass surgery at 49, they said I have genetically high cholesterol and my three major coronary arteries were 100% blocked. I am 95% French. Throw that in the mix, and you’ll see how confused I am by the things written here. LOL


        • frypan100 November 4, 2011 at 12:57 pm #

          I’d like to add, that i do not eat what the french do, I’m in america, I think that has something to do with it too.


          • John Q May 21, 2012 at 9:18 pm #

            It has everything to do with it, cut out the breads, sugars and excess carbs. Add more meat and dairy to your diet. It’s never too late to recover.


            • Karnak May 23, 2012 at 9:11 pm #

              Last time I checked, French eat quite a lot of bread, pasta, rice and potatoes. That sounds to me like a lot of carbs. One difference though is that they seem to east more slowly in general.



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