Monitoring Trends and Determinants in Cardiovascular Disease - MONICA


Observational series for cardiovascular and cerebrovascular mortality and morbidity.


To evaluate trends in cardiovascular and cerebrovascular mortality and morbidity in 41 collaborative centers.

Study Design

Study Design:

Patients Screened: Not given
Patients Enrolled: Approximately 15 million
Mean Follow Up: 10 years

Primary Endpoints:

Trends in the incidence rate of cardiac events and trends in case fatality (the number of fatal events divided by the number of fatal and nonfatal events).

Drug/Procedures Used:

Observational series

Principal Findings:

Age-standardized annual rates of acute MI and coronary death ranged from 915/100,000 in Finland to 76/100,000 in China for men aged 35-64. For women, rates ranged from 256/100,000 in the UK to 30/100,000 in Spain. Case-fatality rates at 28 days ranged from 37% to 81% for men and 31% to 91% for women.

Considerable analysis has been performed for various risk factors and their effect on cardiovascular morbidity and mortality. On preliminary analysis at 10 years, there is no strong relationship for the risk score (a combined value for smoking, blood pressure, cholesterol, and body mass index) or for the risk factors considered separately in explaining trends in coronary event rates. In general, the MONICA data show that for a given level of risk factor change, there are large differences in associated changes in event rates.

Preliminary analysis of 10-year trends indicates a strong relationship between changes in a simple index of coronary care and changes in case fatality: the better the improvement in care, the greater the reduction in case fatality. This finding is significant for both men and women, and it also applies to the event rate and the case mortality rate.


This large study, a project of the World Health Organization, compares populations rather than patients. It represents a significant effort to broaden our understanding of the global burden of cardiovascular and cerebrovascular disease.


1. Circulation 1994; 90:583-612. Myocardial infarction and coronary deaths
2. Stroke 1997; 28:1367-74. Stroke incidence and mortality
3. Presented at the XXth Congress of the European Society of Cardiology, Vienna, 1998

Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Lipid Metabolism, Nonstatins, Smoking

Keywords: Cholesterol, Body Mass Index, Cerebrovascular Disorders, Coronary Disease, Risk Factors, Blood Pressure, Cost of Illness, Smoking

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