title: Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations.
abstract: BACKGROUND
  From the mid-1980s to mid-1990s, the WHO MONICA Project monitored coronary events and classic risk factors for coronary heart disease (CHD) in 38 populations from 21 countries. We assessed the extent to which changes in these risk factors explain the variation in the trends in coronary-event rates across the populations.
  
  
  METHODS
  In men and women aged 35-64 years, non-fatal myocardial infarction and coronary deaths were registered continuously to assess trends in rates of coronary events. We carried out population surveys to estimate trends in risk factors. Trends in event rates were regressed on trends in risk score and in individual risk factors.
  
  
  RESULTS
  Smoking rates decreased in most male populations but trends were mixed in women; mean blood pressures and cholesterol concentrations decreased, bodymass index increased, and overall risk scores and coronary-event rates decreased. The model of trends in 10-year coronary-event rates against risk scores and single risk factors showed a poor fit, but this was improved with a 4-year time lag for coronary events. The explanatory power of the analyses was limited by imprecision of the estimates and homogeneity of trends in the study populations.
  
  
  CONCLUSIONS
  Changes in the classic risk factors seem to partly explain the variation in population trends in CHD. Residual variance is attributable to difficulties in measurement and analysis, including time lag, and to factors that were not included, such as medical interventions. The results support prevention policies based on the classic risk factors but suggest potential for prevention beyond these.
authors.affiliation: Department of Epidemiology and Health Promotion, National Public Health Institute (KTL), Helsinki, Finland. kari.kuulasmaa@ktl.fi
authors.forename: K
authors.initials: K
authors.lastname: Kuulasmaa
authors.forename: H
authors.initials: H
authors.lastname: Tunstall-Pedoe
authors.forename: A
authors.initials: A
authors.lastname: Dobson
authors.forename: S
authors.initials: S
authors.lastname: Fortmann
authors.forename: S
authors.initials: S
authors.lastname: Sans
authors.forename: H
authors.initials: H
authors.lastname: Tolonen
authors.forename: A
authors.initials: A
authors.lastname: Evans
authors.forename: M
authors.initials: M
authors.lastname: Ferrario
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D005260:Female; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D002784:Cholesterol