Background To assess the implication of a possible continuation of the decline in ischaemic heart disease (IHD) mortality in the future.

Methods Annual rates of decline in IHD mortality from 1980–2005 were determined for the national populations of the Netherlands, UK, France and four Nordic countries through regression analysis and used to extrapolate mortality rates until 2030. Through cause-elimination life tables we determined the impact of IHD on life expectancy at birth.

Results In all countries, IHD mortality rates among both sexes declined incessantly until 2005. Age-adjusted mortality rates would have declined by about 50% in 2030 compared to 2005 if past trends were to continue. The impact of IHD on life expectancy at birth would decline by about 25–50% in most populations. The absolute numbers of IHD deaths would decline slowly or even increase in some countries mainly because of population ageing.

Conclusions If current IHD mortality trends continued, IHD would lose much of its importance as a cause of premature death in the near future. As the incidence and disabling impact of IHD might decline much less, prevention of IHD-related disability instead of mortality may become increasingly important in the future.