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Trends in coronary risk factors in the WHO MONICA project
A Evans1, H Tolonen, H W Hense
1Department of Epidemiology and Public Health, The Queen's University of Belfast, Mulhouse Building, Belfast BT12 6BJ, UK. a.evans@qub.ac.uk
Insights
The World Health Organization MONICA Project monitored coronary heart disease risk factors over ten years. While blood pressure and cholesterol trends improved, rising smoking rates in women and increasing body mass index (BMI) in both sexes are public health concerns.
Area of Science:
- Cardiovascular Epidemiology
- Public Health Surveillance
- Preventive Cardiology
Background:
- The World Health Organization (WHO) MONICA Project aimed to link coronary heart disease (CHD) event rates with classic risk factor trends.
- Monitoring occurred over a decade (1979-1996) across 38 populations in 21 countries on four continents.
Purpose of the Study:
- To assess trends in major coronary heart disease risk factors across diverse international populations.
- To understand the relationship between changes in risk factors and CHD/stroke event rates.
Main Methods:
- Utilized a standardized protocol for at least two to three independent surveys.
- Employed random sampling within study populations, spaced throughout the ten-year period.
- Monitored key risk factors including smoking, blood pressure, cholesterol, and body mass index (BMI).
Main Results:
- Smoking rates declined in most men (35-64 years) but increased in most women.
- Systolic blood pressure showed decreasing trends in the majority of centers for both sexes.
- Cholesterol levels generally trended downwards, and body mass index (BMI) showed a significant increase in many male and female populations.
Conclusions:
- It is feasible to monitor classic CHD risk factors in diverse populations over ten years using repeated surveys.
- While overall risk factor trends are largely downwards, increasing smoking in women and rising BMI in both sexes present significant public health challenges.
Background:
The World Health Organization (WHO) MONICA Project was established to determine how trends in event rates for coronary heart disease (CHD) and, optionally, stroke were related to trends in classic coronary risk factors. Risk factors were therefore monitored over ten years across 38 populations from 21 countries in four continents (overall period covered: 1979-1996).
Methods:
A standard protocol was applied across participating centres, in at least two, and usually three, independent surveys conducted on random samples of the study populations, well separated within the 10-year study period.
Results:
Smoking rates decreased in most male populations (35-64 years) but in females the majority showed increases. Systolic blood pressure showed decreasing trends in the majority of centres in both sexes. Mean levels of cholesterol generally showed downward trends, which, although the changes were small, had large effects on risk. There was a trend of increasing body mass index (BMI) with half the female populations and two-thirds of the male populations showing a significant increase.
Conclusions:
It is feasible to monitor the classic CHD risk factors in diverse populations through repeated surveys over a decade. In general, the risk factor trends are downwards in most populations but in particular, an increase in smoking in women in many populations and increasing BMI, especially in men, are worrying findings with significant public health implications.
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