PREVENTION AND TREATMENT - BOTH WORK,
SAYS WHO STUDY ON HEART DISEASE
The results from the WHO MONICA Project (1) - the largest
community-based study on heart disease ever undertaken - were published in the UK medical
journal, The Lancet, on 26 February 2000. The two reports show that heart disease
rates are related to changes in major coronary risk factors and to the introduction of new
The WHO MONICA Project - an international collaboration of researchers
from 21 countries (2) - studied more than 30 populations, mainly from Europe, over a
period of ten years, from the mid-1980s to the mid 1990s. More than seven million men and
women aged between 35 and 64 years of age were monitored to examine if and how certain
coronary risk factors and new treatments for heart disease contribute to the decline or
rise of heart disease rates in these communities.
The risk factors studied by MONICA included cigarette smoking, blood
pressure, blood cholesterol and body weight. Treatments taken into consideration included
aspirin, beta blockers, ACE-inhibitors, thrombolytics (clot-busters) and coronary artery
surgery. All of these are known from other research studies to determine risk or survival
from heart disease in individuals.
Heart disease rates fell in most of the populations studied, as did
cigarette smoking in men, blood pressure and blood cholesterol. Smoking in women showed a
mixed picture and weight rose in both men and women in most populations. According to WHO,
most of the trends are moving in the right direction. However, the increase in obesity,
and in smoking among women, requires immediate public health action.
Taking all populations as a whole, decline in smoking seems to have
contributed most to the reduction in the risk of heart disease in men. In women, decrease
in blood pressure emerged as the strongest determinant.
Overall, it was found that the relation between the fall in heart
disease rates and the change in risk factors was more apparent in men than in women.
Countries where large reductions in several risk factors have taken
place are experiencing remarkable declines in heart attacks: in men, for example, Finland
and New Zealand showed a reduction of 7% per year, USA 6%, and Australia 5%. On the other
hand, populations mainly from Eastern Europe and China, where the risk factors have been
found to be rising, have experienced increases in heart disease.
Dr Kari Kuulasmaa, lead author of the risk factor report and head of
the MONICA Data Centre in Helsinki, Finland, commented: "The results underline that
important changes in risk factors are happening across countries. But they also show that
many of the trends in heart disease over a ten-year period cannot be fully attributed to
the risk factor changes that occur at the same time. More work is needed to understand
better how risk factor changes over time impact on heart attack rates in whole
The second report shows that advances in medical treatment in the 1980s
and in the 1990s were related to heart disease rates and survival. However, improvements
in heart disease rates and treatment varied greatly across countries.
"When the MONICA study was started, there was little evidence that
treatment had a real impact on outcomes in heart disease. The recent results are very
positive, but we cannot definitely attribute the benefits to specific drugs. These papers
will initiate considerable discussion among medical experts and are likely to generate
further research in this field", states Professor Hugh Tunstall-Pedoe, University of
Dundee, United Kingdom, lead author of the coronary care report. "Take care of your
risk factors whether or not you have heart disease. If you have heart disease or are at
high risk, be sure to follow your treatment", he added.
According to WHO, the study clearly demonstrates that many of the
countries involved are approaching the problem appropriately by combining strong
preventive efforts with provision of essential medical treatment.
"In the light of shrinking resources for health care worldwide,
the preventive approach is the only way to stop the growing epidemic and deal with the
problem in future generations," states Dr Ingrid Martin, head of the WHO
Cardiovascular Diseases Programme that coordinates the MONICA Project.
"This has implications especially in
developing countries where heart disease and stroke epidemics are rapidly advancing. In
the long run, a preventive approach with emphasis on better diet, more exercise and
reduction in smoking will also prevent other noncommunicable diseases, such as diabetes,
certain cancers and chronic lung diseases", she adds.
(1) Monitoring trends and determinants in cardiovascular
(2) Australia, Belgium, Canada, China, Czech Republic, Denmark,
Finland, France, Germany, Iceland, Italy, Lithuania, New Zealand, Poland, Russia, Spain,
Sweden, Switzerland, United Kingdom (Northern Ireland and Scotland), USA, Yugoslavia.
For further information from WHO,
journalists can contact Ms Susanna Gorga, WHO, Geneva, tel
(+41 22) 791 2592, fax (+41 22) 791 4755. E-mail: firstname.lastname@example.org or Dr Ingrid Martin, Coordinator, NCD/CVD,
WHO, Geneva, tel (+41 22) 791 3441, fax (+41 22) 791 4151.
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