Large intercommunity difference in cardiovascular drug consumption: relation to mortality, risk factors and socioeconomic differences.

A comparison of cardiovascular drug sales and cardiovascular mortality was made between two Swedish counties (Värmland and Malmöhus) and between two rural municipalities in those counties (Torsby in Värmland and Hörby in Malmöhus). Cardiovascular drug sales (defined daily doses (DDD) per 1,000 inhabitants per day) during 1986-87 were 25% higher in Värmland than in Malmöhus county, and the age-standardized mortality of coronary heart disease (CHD) was 36% (men) and 54% (women) higher. In Torsby, age-standardized CHD mortality (1986-87) was 71% (both sexes) higher than in Hörby, and the sales of cardiovascular drugs (1978-87) were 58% higher. Statistically, every third inhabitant of Torsby took one DDD of a cardiovascular drug every day, as compared to every fifth inhabitant in Hörby. In Torsby there was a 6% higher serum cholesterol, 71% lower tap water hardness, 33% lower income, a lower educational level, a three-fold higher unemployment rate, and a different ethnic background (20% eastern Finnish ancestry), all factors assumed to promote a high CHD rate. All of these factors may contribute to the higher CHD mortality, which was in turn reflected in higher sales of cardiovascular drugs.