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American Heart Association Comment: Contributions Of Trends In Survival And Coronary-Event Rates To Changes In Coronary Heart Disease Mortality

American Heart Association

10-Year Results From 37 WHO MONICA Project Populations

A paper published in the May 8 issue of Lancet confirms that the number of deaths due to coronary heart disease, the cause of heart attacks, has declined. According to the report, the major contributor to the decline among the populations studied is a reduction in the number of heart attacks. This trend is responsible for about two thirds of the decline in deaths. The report attributes the other third of the declining death rate to an increase in the number of people surviving heart attacks.

"Is the decline in deaths due to heart disease a result of improved medical care, including appropriate modification of risk factors, in people who have had heart attacks?" asks Valentin Fuster, M.D., Ph.D., president of the American Heart Association and director of the Cardiovascular Institute, Mount Sinai Medical Center in New York City.

"Or is the decline a result of decreased incidence of first heart attacks due to more effective primary control of risk factors for heart disease?" adds Fuster. Risk factors for heart disease are cigarette smoking, high blood pressure, high blood levels of cholesterol, physical inactivity, obesity and diabetes.

The decline in deaths from heart disease could be due to both improved medical care and more effective management of risk factors in members of the general population before they have their first heart attacks, says Fuster. He added that the study known as the MONICA project appears to support the latter.

These questions will be more fully addressed in the future by the MONICA project, which Dr. Fuster describes as an excellent study, partly because its participants represent many population groups including the American public.

The answers to these questions are critical for determining whether our limited health resources should be devoted more to preventing the first heart attack from occurring or preventing additional heart attacks in people who already have had one, adds Fuster. The World Health Organization-sponsored project called MONICA (Monitoring trends and determinants in cardiovascular disease) is the largest collaborative study of heart disease ever undertaken. It tracks heart attack rates, risk factors and heart disease treatment in 37 medical centers, in 21 countries, on four continents, over a 10-year period beginning in the early1980s.

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For more information contact Cathy Yarbrough, 214-706-1340 or Florence Antoine, 214-706-1135, in AHA's News Media Relations office.


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