INFORMATION PROVIDED BY THE MONICA PROJEC T

The authors review the various aspects of the MONICA project (Monitori ng of Trends and Determinants in Cardiovascular Diseases) coordinated by the World Health Organization. This study comprises, in a defined g eographical or administrative entity, an infarction Registry, two or t hree population surveys and two or three surveys concerning the treatm ent of the acute phase of myocardial infarction. It is a ten-year stud y conducted by 39 collaborative centres in 4 continents. The main hypo theses of this study have not yet been verified, as some centres have not completed the 10 years of infarction recording and/or the last pop ulation survey. However, the results collected to date and reported in about ten publications grouping all centres, and more than 500 articl es published by various centres, demonstrate the wealth of precious in formation for clinicians provided by this public health project. For e xample, the infarction Registry demonstrates marked regional differenc es in myocardial infarction rates in the population and therefore mark ed differences in acute coronary bed requirements. The Registry also c onfirms the higher mortality rates in women and at the end of infarcti on compared to men. Population surveys can be used to follow the cours e of the main coronary risk factors and to compare the levels of risk factors in different centres. Regional differences clearly show that a more or less aggressive approach to primary prevention is required. F inally, the presence of an infarction Registry and population surveys allow the elaboration of case-control study protocols, several example s of which are mentioned by the authors. All of these techniques will be able to more clearly define the aetiology of coronary heart disease and, consequently, the reduction of this disease in the population by adequate primary and secondary prevention.