cause #1 – heart disease and stroke

This is the first in the How Australians Die series which focuses on the country’s five leading causes of death and how we can reduce the rates of these diseases. Tomorrow’s article will explore the second leading cause of death: cancers.

Diseases of the heart and the vessels circulating in it are the number one reason people die in Australia, and we’re not the only ones. They are the number one cause of death worldwide.


According to the Australian Bureau of Statistics, ischemic heart disease (IC) is the main cause of death in australia. In 2014, 20,173 people died from it.

But ischemic heart disease is not really the disease itself. Rather, it is the term used to cover the clinical manifestations of coronary heart disease such as heart attacks and angina pectoris.

The How Australians Die series combined all cancer deaths to make it the second leading cause of death after heart disease and stroke. Alzheimer’s disease comes third, respiratory diseases fourth and diabetes fifth.

Coronary disease

Coronary artery disease is almost always a consequence of atherosclerosis. It is a buildup of cholesterol and other materials in the walls of our arteries (tubes that carry blood and oxygen to the heart). The buildup can cause a heart attack and block access to the brain, leading to stroke – another of Australia’s leading killers.

Ischemia describes an insufficient supply of oxygen to the heart muscle. Lack of oxygen can cause chest discomfort, like tightness or compression known as angina pectoris. This is most often brought on by exercise, but is more serious when it occurs at rest.

The persistence of angina over time, especially at rest, can lead to the death of certain heart muscles. This is called an acute coronary syndrome, or colloquially, a heart attack. We used to call it myocardial infarction. No wonder people find the terminology confusing.

The Australian Bureau of Statistics class ischemic heart disease as the leading cause of death in Australia. Cerebrovascular disease (stroke) ranks third, heart failure ranks seventh; hypertensive diseases are at 13, and cardiac arrhythmias at 19.

But there is considerable overlap between these, which is why this article has combined them under one umbrella. Hypertension (high blood pressure), for example, is a major cause of stroke and a risk factor for coronary heart disease. At least half of heart failures are due to coronary artery disease, while the most common cardiac arrhythmia (irregular heartbeat), atrial fibrillation, is often caused by hypertension, heart failure, or coronary artery disease. In addition, atrial fibrillation is the cause of approximately one third of strokes.

Although ischemic heart disease was responsible for 20,173 deaths in 2014, the number of deaths from the above circulatory diseases in 2014 was 38,741.

History of heart disease

Heart disease is not new. CT scans of egyptian mummies who lived 3,500 years ago show that they had narrowings in their arteries, which means they had coronary artery disease. Pharaoh Merneptah, for example, who died in 1203 BC. AD, suffered from severe coronary heart disease.

CT scans show Pharaoh Merneptah suffered from atherosclerosis.
G. Elliot Smith/Wikimedia Commons

the real and documented epidemic of heart disease occurred after World War II. This could partly be explained by higher rates of smoking, high blood pressure and poor diet after and during the war. Rates rose for three decades during this time.

Then they fell; first in Australia and the United States, then in other developed countries. Half of this decline could be attributed to public health measures such as tobacco control and the availability of treatments for blood pressure and cholesterol; the other half to better treatment for people with heart disease.

A province in Finland, North Karelia, initially held the dubious record for the highest rates of heart disease in the world. In the early 1970s, the region had about 672 per 100,000 people die of heart disease. The coat then passed to Eastern Europe and Russia where rates are currently 320 per 100,000 people. This is astonishing compared to Australia where the rate is 54 per 100,000.

In 1990, heart disease was the third leading cause of death in developing countries, but in 2013 it was number one. The rates went from 70 per 100,000 people to 91 per 100,000 people during those years respectively. This is because the developing world has learned the habits of the developed world. There is now more people in the world who are overweight than underweight.

Hypertensive diseases are increasing in most developing countries, along with diabetes, while smoking remains common. Infections and trauma once killed people too young to have heart disease, but that’s no longer the case thanks to antibiotics, vaccinations and better safety standards.

In 1990, there were 12.3 million deaths worldwide from heart disease. In 2013, this had risen to 17.3 million. Most of this 40.8% increase occurred in developing countries and among disadvantaged people in developed countries like Australia.

ABS Causes of Death, Australia, 2014, CC BY-SA

All countries in the world are at some point in the transition from low to high to moderate rates of heart disease related to their stage of development. There is nothing inevitable about heart disease being the number one cause of death in Australia or the world as a whole.

The stereotype of a harassed executive having a heart attack no longer applies. Heart disease has become a blue-collar disease or a disease initially encountered in urban populations in developing countries.

Where to go from here?

The documented epidemic of heart disease occurred after World War II.
Audiovisual design |, CC BY

Today (and for the foreseeable future), global rates of heart disease are determined by development, inequality and prosperity. The death rate from heart disease was almost double for Australians in the lowest socio-economic group compared to the highest socio-economic group, and 20% higher for those living in remote to very remote areas compared to those in large cities. They were 40% higher for Indigenous Australians compared to their non-Indigenous counterparts.

For years we have been comforted by declining death rates from heart disease in Australia. But as the population grows, ages and people survive diseases such as cancer earlier in life, the burden on the healthcare system has not diminished as much as the rates suggest.

Alarmingly, among people aged 55 to 69, the rates and absolute number of people dying from heart disease have increased, according to the latest data.

As Australia has become one of the fattest nations in the world, with rising rates of diabetes and other metabolic consequences leading to heart disease, overweight and sedentary men and women with multiple risk factors risk replaced thin male smokers who died of heart disease in their 50s.