This research highlights the fact that more than a third of people who had a heart attack died suddenly, and before they had a chance of being treated in hospital.

Professor Sir Charles George, medical director of the British Heart Foundation

It looked at cases of acute myocardial infarction (MI), or heart attack, in Scotland between 1986 and 1995.

It found that 83,365 people died from MI out of hospital and without previous hospital admission.

The study also found that 117,749 were admitted with a first acute MI, of whom 37,020 died within a year.

Deaths outside hospital accounted for 69% of all deaths from heart attack.

The risk of sudden, out-of-hospital deaths was shown to increase with age.

In 1995, just 40% of elderly people survived to reach hospital, compared with 80% of men and women younger than 55.

The research also found death rates were substantially higher in deprived socioeconomic groups than in affluent groups, especially in people younger than 65 years.

Coronary heart disease

Deaths from coronary heart disease have halved in most developed countries in the past three decades, and much credit for this fall has been given to modern cardiological treatments.

However, the report claims that two-thirds of this fall can be attributed to better prevention measures, such as improved diet and exercise, and a reduction in smoking.

Most previous reports have concentrated on hospital admissions, failing to address the serious problem of sudden deaths.

Professor Sir Charles George, medical director of the British Heart Foundation, who funded the research project, said: "We have known for some time that Scotland has the highest rate of Coronary Heart Disease (CHD) in the UK.

Healthier eating

"But these findings reinforce the fact that it is predominantly people in lower-socio economic groups who are most at risk of dying from a heart attack and need most help in learning how to prevent CHD.

"It appears that health messages are getting through to more affluent and better educated people.

"A decrease in smoking and healthier eating habits has resulted in a steady decline in death rates in Scotland over the past decade - but this is not mirrored in people living in disadvantaged areas.

"This research highlights the fact that more than a third of people who had a heart attack died suddenly, and before they had a chance of being treated in hospital.

"The most important message, therefore, remains the same: prevention is better than cure.

"People's best chance of beating heart disease - whether rich or poor - is to learn how to take charge of their heart health from an early age."