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Heart disease mortality declining with fewer and less deadly attacks

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7194.1307 (Published 15 May 1999) Cite this as: BMJ 1999;318:1307
  1. Zosia Kmietowicz
  1. London

    The decline in mortality from coronary heart disease seen in some countries over the past decade is the result of a reduction in the number of events rather than improved survival, according to the 10 year study monitoring trends and determinants in cardiovascular disease (MONICA).

    Investigators from the World Health Organisation's MONICA project monitored the trends in coronary heart disease across 37populations in 21 countries for 10 years, from the early 1980s. The first definitive results of the study, published last week, showed that during this time 166000 coronary events were registered in men and women aged between 35 and 64 years (Lancet 1999;353;1547-57). Results showed that each year deaths from coronary heart disease in most countries were falling by an average of 2.7%among men and 2.1%among women. Changes in non-fatal rates were smaller—a reduction of 2.1%in men and 0.8%in women. Coronary event rates (fatal and non-fatal combined) fell more (2.1%in men; 1.4%in women) than case fatality (0.6%in men; 0.8%in women).

    Commenting on the findings, Professor Hugh Tunstall-Pedoe of the cardiovascular epidemiology unit at Dundee University, a MONICA steering group member, said: “The main point of the study was that the reduction seen in mortality from coronary heart disease was caused two thirds by the fact that there are fewer heart attacks and one third by the fact that heart attacks are less deadly.” The researchers concluded that the major determinant of the decline in mortality from coronary heart disease was whatever drives changing rates of coronary events.

    Men continued to outnumber women in terms of deaths from coronary heart disease by four to one. However, the data showed enormous differences in mortality both between and within countries. The well known north-south divide across Europe persisted.


    Embedded Image

    Annual trends in rates of coronary heart disease in men included in the monica study

    Credit: REPRODUCED WITH PERMISSION FROM LANCET 1999;353:1547-57)

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