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Trends in stroke and coronary heart disease in the WHO MONICA Project
Thomas Truelsen1, Markku Mähönen, Hanna Tolonen
1World Health Organization Noncommunicable Diseases and Mental Health/Cross Cluster Surveillance, CH-1211 Geneva 27, Switzerland. truelsent@who.int
Insights
Trends in coronary heart disease (CHD) and stroke mortality and event rates differ significantly, especially in men, challenging assumptions of similar cardiovascular disease trajectories. These findings highlight population-specific variations in disease trends.
Area of Science:
- Cardiovascular epidemiology
- Public health research
- Clinical outcomes analysis
Background:
- Coronary heart disease (CHD) and stroke are leading causes of death and disability globally.
- Both conditions share common risk factors, suggesting potentially similar epidemiological trends.
Purpose of the Study:
- To compare 10-year trends in mortality, event rates, and case fatality between CHD and stroke.
- To investigate whether trends in these major cardiovascular diseases align as expected due to shared risk factors.
Main Methods:
- Utilized data from the WHO MONICA Project, analyzing 60,763 CHD events and 10,442 stroke events.
- Examined trends in men and women aged 35-64 across 15 international populations over 23.4 million person-years.
- Compared mortality, event rates, and case fatality for CHD and stroke.
Main Results:
- Significant differences in mortality trends were observed between CHD and stroke in men (P=0.001), but not women.
- Event rate trends differed significantly for both sexes (men P<0.001; women P=0.011).
- Case fatality trends showed no significant differences between CHD and stroke for either sex.
Conclusions:
- Mortality rates, event rates, and case fatality trends for CHD and stroke diverge substantially.
- These differences exist both within and between the studied populations.
- The findings indicate distinct epidemiological trajectories for CHD and stroke, contrary to expectations based on shared risk factors.
Background And Purpose:
Coronary heart disease (CHD) and stroke are leading causes of death and disability. Because they share major common risk factors, it would be expected that trends in mortality and incidence of these 2 major cardiovascular diseases would be similar.
Methods:
Data from the World Health Organization (WHO) Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project were used to compare 10-year trends in mortality, event rates, and case fatality from both CHD and stroke. Fifteen populations in the WHO MONICA Project provided data on both CHD (60 763 events) and stroke (10 442 events) in men and women aged 35 to 64 years (23.4 million person-years of observation in total).
Results:
Trends for the 2 cardiovascular diseases varied within and between populations, and when data from all populations were combined, trends in CHD and stroke mortality differed in men (P=0.001) but not in women, whereas trends in event rates differed significantly in both men and women (P<0.001 and P=0.011, respectively). The differences in trends for CHD and stroke case fatality were not statistically significant in either men or women. In sensitivity analyses, differences in trends in event rates remained statistically significant in men (P<0.001) but not in women.
Conclusions:
Trends for CHD and stroke mortality rates, event rates, and case fatality differ substantially between and within the study populations.
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