MAJOR CARDIOVASCULAR STUDY SHOWS SUBSTANTIAL REGIONAL DIFFERENCES

Men living in North Karelia (Finland), Glasgow (United Kingdom), Kuopio (Finland) and Belfast (United Kingdom), and women living in Glasgow (United Kingdom), Belfast (United Kingdom), Newcastle (Australia) and Warsaw (Poland) have the highest average rates of heart disease among 170,000 people studied over a 10-year period from the mid 1980s to the mid 1990s.

The lowest average heart attack rates in women over the ten years occurred in Catalonia (Spain), Beijing (China), Toulouse (France) and Brianza (Italy). Women's heart attack rates in Glasgow were eight times higher than those in Catalonia, for example. Among men, the lowest average heart attack rates over the ten years occurred in Beijing (China), Catalonia (Spain), Vaud-Fribourg (Switzerland) and Toulouse (France); rates in North Karelia were ten times higher than those in Beijing, for example.

These are just some of the findings from the World Health Organization (WHO)-sponsored "MONICA" (from MONItoring CArdiovascular disease) Project which studied 170 thousand heart attacks around the world over a 10 year period to get an accurate picture of cardiovascular disease levels and trends.

The first findings from this, the world's largest ever study of heart disease, are being published in the Lancet (a United Kingdom medical journal) on 8 May 1999. The MONICA Project tracked heart attack rates, risk factors and coronary care in pre-defined populations in 37 countries from the mid-1980s to the mid-1990s.

The greatest fall in coronary event rates in men occurred in three north European populations: the leader being North Karelia, Finland (which had the highest levels at the start of the study), Kuopio (also in Finland) and Northern Sweden. These three regions were followed by Newcastle (Australia). With the exception of Catalonia (Spain), male populations experiencing notable increase in rates were predominantly from central and eastern Europe and Asia. In women, the populations experiencing significant increases again tended to be from central and eastern Europe and Asia, but the general pattern of increases and decreases appeared to be less consistent.

Trends in heart attack rates were similar to those in the routine mortality statistics, even though the latter tended to underestimate death rates from coronary disease in many countries. The WHO MONICA Project thus validates the use of routine death data for monitoring long term trends in death from heart disease.

Where mortality rates were falling, change in survival contributed one third and change in heart attack rates two thirds, on average, of the total change in survival rates, indicating the importance of both the prevention of heart disease and improved care of acute events.

The lead author of the report was Professor Hugh Tunstall-Pedoe of the Cardiovascular Epidemiology Unit of Dundee University at Ninewells Hospital, Scotland. He worked with Dr Kari Kuulasmaa, Chief Scientist of the MONICA Project and three of his colleagues from the MONICA Data Centre in the National Public Health Institute, Helsinki, Finland, and with Professor Philippe Amouyel from the Pasteur Institute of Lille in France.

Professor Amouyel stressed that, "The WHO MONICA study paid great attention to standardization of diagnosis and procedures and to measuring and reporting the performance of the different centres. For the sake of scientific transparency, our procedures and quality control tests, the individual results and the overall scores are being simultaneously published on the internet." (http://www.ktl.fi/publications/monica).

Professor Tunstall-Pedoe said, "This is one of a series of major reports from the WHO MONICA Project. Later ones, in preparation, cover issues such as how much changes in medical treatment and in coronary risk factors are responsible for the changes recorded here in survival and event rates."

"Cardiovascular disease - largely heart attacks and strokes - is the leading cause of death in the world today and will remain so by the year 2020. The WHO MONICA Project is a cause for optimism: heart attack rates are declining in most MONICA centres and there is no reason why these improvements cannot be continued and extended to other countries. WHO has given priority to the prevention and control of cardiovascular diseases, and non-communicable diseases more generally as an indication of its desire to accelerate these favourable trends," said Dr Ruth Bonita, Director of Non-communicable Disease Surveillance at WHO.

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