DECLINING RATES OF CORONARY HEART-DISEASE IN NEW-ZEALAND AND AUSTRALIA, 1983-1993

The authors report the results of 10 years of monitoring of trends in the rates of major nonfatal and fatal coronary events and in case fata lity in Auckland, New Zealand, and in Newcastle and Perth, Australia. Continuous surveillance of all suspected myocardial infarctions and co ronary deaths in people aged 35-64 years was undertaken in the three c enters as part of the World Health Organization's Multinational Monito ring of Trends and Determinants in Cardiovascular Disease (MONICA) Pro ject, For nonfatal definite myocardial infarction, there were statisti cally significant declines in rates in all centers in both men and wom en, with estimated average changes between 2.5% and 3.7% per year duri ng the period 1984-1993, Rates of all coronary deaths also declined si gnificantly in all three populations for both men and women. In absolu te terms, there was, in general, a greater reduction in prehospital de aths than in deaths after hospitalization. Although 28-day case fatali ty remains high at between 35% and 50%, in the Australian centers it d eclined significantly by between 1.0% and 2.9% per year, and in Auckla nd there was also a small decline, However, since most deaths occur ou tside the hospital in people without a previous history of coronary he art disease, an increased emphasis on primary prevention is necessary.