Trends in mortality from coronary heart and cerebrovascular disease in Switzerland, 1969-87

Trends in coronary heart disease in two Belgian areas: results from the MONICA Ghent-Charleroi Study

SETTING

As part of the WHO-MONICA study, acute coronary events have been registered from 1983 until 1992 in the general population aged 25-69 years in two Belgian cities--Ghent in the northern Dutch speaking part of Belgium and Charleroi in the southern French speaking part. Registration of events was done according to an international standard protocol.

OBJECTIVE

To study trends in total, fatal and non-fatal event rates and trends in case fatality rates in these two cities.

MAIN RESULTS

Incidence of CHD was on average 50% higher in Charleroi compared with Ghent in both men and women (attack rate ratio Charleroi/Ghent was 1.5 in both sexes). In both men and women, diverging trends were observed between the two cities for total and non-fatal event rates, while parallel declining trends were observed in fatal event rates and in case fatality rates. In both sexes, total attack rates showed a significant decrease in Ghent and a significant increase in Charleroi. Also in the two sexes, attack rates of non-fatal events increased significantly in Charleroi and remained stable in Ghent. Attack rates of fatal events decreased significantly in men and women in Ghent and in men in Charleroi. Both "total" and "in hospital" case fatality rates declined significantly in both sexes in the two cities.

CONCLUSIONS

Important differences in coronary heart disease (CHD) incidence and CHD trends between Ghent and Charleroi were observed. These differences and trends are interpreted in the context of existing and still growing differences in the overall socioeconomic situation between the north and the south of the country. On the other hand, the efficacy of medical treatment of CHD is comparable in the two regions, as reflected by similar figures and trends for case fatality rates.

Trends in cardiovascular risk factors (1984-1993) in a Swiss region: results of three population surveys

BACKGROUND

This study attempted to assess the time trends in lifestyle and cardiovascular risk factors in the Swiss region of Vaud-Fribourg (population 784,000).

METHODS

Three surveys (1984/1985, 1988/1989, and 1992/1993), based on independent representative samples (n = 3,300) of the population ages 25 to 74, were conducted within the framework of the international WHO-MONICA Project.

RESULTS

The most favorable changes were observed in reported behaviors: increased physical activity in leisure time, healthier dietary habits (switch from unskimmed milk, butter, and meat to skimmed milk, margarine, and fish, with no change for fruits and vegetables), and lower prevalence of regular smoking among men (from 32 to 28%). Body mass index did not vary significantly, apart from an increase in the prevalence of obesity among men (from 11 to 15%). Total cholesterol varied only slightly, while the HDL cholesterol levels decreased steadily (from 1.37 to 1.19 mmol/L among men; from 1.59 to 1.51 among women). Average systolic blood pressure regressed among women (from 127.2 to 124.4 mm Hg), while the prevalence of untreated hypertension increased among older men.

CONCLUSION

The self-reported changes in lifestyle were only partially reflected by favorable trends in objective measurements. Physical activity, even at moderate intensity, and consumption of fruits, vegetables, and fiber in general should be promoted.

[Incidence of use of various myocardial infarct treatments in 2 Swiss regions]

Two regions in Switzerland (Vaud-Fribourg and Ticino) participate in the WHO MONICA project (MONItoring of trends and determinants in CArdiovascular disease). Within this context, all hospitalizations of men for ischemic heart disease will be recorded during a period of ten years. All cases are classified according to uniform criteria, in three categories: definite myocardial infarction, possible myocardial infarction or no myocardial infarction. In 1986, the records were completed with a summary of treatments. The treatment of 334 patients with definite myocardial infarction, aged between 25 and 64 years, surviving after 27 days are analyzed (VD-FR: 217; TI: 117). Results show that anticoagulants were administered in a routine fashion (in 97% of the cases), whilst thrombolysis, applied in 1986 by only one hospital in each area, concerned only 9% of the patients. As compared to Ticino, VD-FR distinguished itself by its significantly higher use of anti-arrhythmia drugs (69% versus 47%; p less than 0.005), nitrates (97% versus 86%; p less than 0.005) and beta-blockers (57% versus 43%; p less than 0.05). Furthermore, patients from VD-FR spent more time in the intensive care unit (6.4 versus 3.7 days; p less than 0.005) and participated more frequently in rehabilitation programmes (47% versus 12%; p less than 0.005). The discussion compares the observed therapy with results published in the literature.