Did MONICA really say that?

Can I have a fag and a chip butty now? Some journalists have claimed, on the basis of the results of the MONICA project, that coronary risk factors no longer matter. Hugh Tunstall-Pedoe, who was involved in the study, explains how the original story was metamorphosed by the media.

Americans' inability to explain their decline in coronary disease spawned the World Health Organisation's MONICA project (MONItoring CArdiovascular disease) in the 1980s. This 10 year study of trends in disease and risk factors recruited 38 populations in 21 countries. Preliminary results were presented at the European Congress of Cardiology in Vienna in August 1998 but individual centres had previously published results.

I drafted the press release accompanying this presentation; it emphasised the value of the data on trends collected from the 38 populations and listed findings for coronary disease rates, 28 day case fatality, smoking, blood pressure, cholesterol, and obesity. Then came the surprises. Although some centres had previously reported no change in case fatality during the revolution in treatment of myocardial infarction of the …