MArtignacco_e110_128

7/30/2019 MArtignacco_e110_128

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Simona Giampaoli

Administrative centreLaboratorio di Epidemiologia e BiostatisticaInstituto Superiore di SanitaViale Reginea Elena,299,00161 Rome,ItalyT +39 06 49902985; F +39 06 49387069

DescriptionThe Italian Coordinating Centre is based in aninstitute whose involvement in cardiovascularepidemiology goes back to the Seven CountriesStudy. At the start of MONICA it was activethrough its then Principal Investigator, Alessan-dro Menotti,in setting up three MONICA Collab-orating Centres in Italy,although that nearest toRome,Italy-Area Latina lost its funding early andwithdrew,see #84 Former MONICA Populations.Alessandro Menotti was also a member of thefirst MONICA Steering Committee and con-tributed to the development of the MONICAprotocol. Recently, the Coordinating Centres

involvement in MONICA has been less apparentthan that of its French equivalent, although itsnational role in coordinating cardiovascular epi-demiology has continuedas demonstrated byits involvement in Italian collaborative publica-tions.

Key personnelPI: Simona Giampaoli. Former PI: AlessandroMenotti.

PublicationsSee publications of Italian MCCs.

Simona Giampaoli

110 MONICA MONOGRAPH AND MULTIMEDIA SOURCEBOOK

#67 Italy-Country Coordinating Centre

BRI FRI

Alessandro Menotti

q crucial when MONICA began

q more subtle role at the finish


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MONICA POPULATIONS 111

Milan and the Swiss border. An urban industrial-ized population with among the highestaverage incomes in Italy, it experienced someeconomic recession in the early 1990s.The totalpopulation in 1991 was 850 000.

Funding1. Assessorato alla Sanit della Regione Lombar-dia. 2. Italian National Research Council.

DatesCoronary-event registration: 198594, (199798*). Coronary care: 1986, 198994 (199798*).Population surveys: 1986/1987, 1989/1990(1992*) and 1993/4. Stroke-event registration:(1998*). (*) = not in WHO MONICA database.

Additional descriptionCoronary mortality and event rates for men andwomen were in the bottom fifth of the MONICAdistribution. Declining event rates and case

fatality contributed to falling mortality rates butunequally in the two sexes. Attack rates werestable over time if milder events were included,which suggests diminishing severity of disease.Smoking decreased in men, but not in women;blood pressure decreased in both sexes;total cholesterol and BMI (body mass index)increased between the middle and final surveys.Social disparities have been observed in riskfactors and in the trends in 28-day case fatality,presumably from pre-hospital factors, as hospi-tal treatment is not biased.

Local research interestsSocio-occupational disparities in coronary

disease and its treatment.Simplified methods ofregistration.Prospective follow-up studies.

Continuing activityCoronary and stroke-event registration intermit-tently. Population surveys have ceased. Cohortstudies continue using stored material fornested case-control studies.

Key personnelPIs: Giancarlo Cesana, Marco Ferrario.Populationsurveys: Roberto Sega. Chief Biochemist: PaoloMocarelli. Coronary care: Franco Valagussa andFelice Achilli. Data management: Giovanni DeVito. Event registration: Maria Teresa Gussoni.

Selected publications1. Ferrario M, Sega R, Cesana GC. Lessons from

the MONICA Study in Northern Italy.Journalof Hypertension, 1991, 9(Suppl 3):S7S14.PMID:1798004.

2. Cesana GC, Ferrario M, Sega R, Bravi C,Gussoni MT, De Vito G, Valagussa F. [Drop incardiovascular and coronary mortality inLombardia, 19691987. Evaluation of relia-bility of the estimates and possible explain-ing hypothesis.] Giornale Italiano diCardiologia, 1992, 22:293305. (I talian).PMID:1426772.

3. Ferrario M, Cesana GC, Heiss G, Linn SA,Mocarelli P, Tyroler HA. Demographic and

behavioural correlates of high. densitylipoprotein cholesterol. An international

Marco Ferrario

Giancarlo Cesana

Brianza

#68 Italy-Brianza (ITA-BRI, IT)

q among the lowest MONICA coronary-

event rates

q declining mortality and event rates

and case fatalityq studies of socioeconomic differences

q gene-environment interaction from

nested case-control studies

MCC 57: Area BrianzaSingle Reporting Unit.

Administrative centreResearch Centre for Chronic DegenerativeDiseases, Department of Internal Medicine,Department of Prevention and Health Biotech-

nology,University of Milan-Bicocca,

Via Cadore 48, 20052 Monza, ItalyT +39 039 233 3098; F +39 039 365 378

PopulationResidents, aged 2564, of 73 municipalities inBrianza, Lombardy, northern Italy, between

comparison between northern Italy and theUnited States. International Journal of Epi-demiology,1992,21:665675.PMID:1521969.

4. Ferrario M, Cesana GC. [Socioeconomicstatus and coronary disease: theories,research methods,epidemiological evidenceand the results of Italian studies.] La Medic-ina del Lavoro, 1993, 84:1830. (Italian).PMID:8492732.

5. Cesana GC, De Vito G, Ferrario M, Sega R,Mocarelli P. Trends of smoking habits inNorthern Italy (19861990) (WHO MONICAProject in Area Brianza). European Journal ofEpidemiology, 1995, 11:251258.

PMID:7493656.6. Cesana GC, Ferrario M, De Vito D, Sega R,

Grieco A. [Evaluation of the socioeconomicstatus in epidemiological surveys: hypothe-ses of research in the Brianza area MONICAproject.] La Medicina del Lavoro, 1995,86:1626. (Italian). PMID:7791660.

7. Achilli F, Valagussa L,Valagussa F, De Vito G,Ferrario M, Cesana G. [Changes in the treat-ment of cardiac emergencies and their influ-ence on fatalities. Data from the MONICAProject, Brianza Area.] Giornale Italiano diCardiologia, 1997, 27:790802. (Italian).PMID:9312507.

8. Ferrario M, Sega R, Chatenoud L, Mancia G,Mocarelli P, Crespi P, Cesana GC, for the

MONICA- Brianza Research Group. Timetrends of major coronary risk factors in anorthern Italian population (19861994).How remarkable are socio-economic differ-ences in an industrialised southern Euro-pean population? International Journal ofEpidemiology, 2001, 30:285297.PMID:11369728.

9. Ferrario M, Cesana G, Vanuzzo D, Pilotto L,Sega R, Chiodini P, Giampaoli S. Surveillanceof ischaemic heart disease: results from theItalian MONICA populations. InternationalJournal of Epidemiology, 2001, 30: Suppl1:S23-S29. PMID:11759847.

Marco Ferrario, Giancarlo Cesana


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Loggia

Diego Vanuzzo

Area

q one of the highest cardiovascular

disease rates in Italy

q MONICA-Friuli now the model for

collecting cardiovascular data in Italyq hosted 8th Council of Principal

Investigators meeting,April 1994

#69 Italy-Friuli (ITA-FRI, IF)

Developing a risk chart of the Italian population.National risk-factor surveillance system (DiegoVanuzzo, Co-Director),using the MONICA proto-col, to plot risk-factor distribution and controlacross Italy. (Initial results can be found at:www.iss.it.)

Key personnelPI 1995: Diego Vanuzzo. Former PI1995:Giorgio Antonio Feruglio. Co-PI: Lorenza Pilotto.Staff: GB Cignacco,G Zanata, M Scarpa,R Marini,M Spanghero, G Zilio.

Selected publications1. Feruglio GA, Vanuzzo D. [Ischemic heart

disease in Italy: dimensions of the problem.]Giornale Italiano di Cardiologia, 1989,19:75462. (Italian). PMID: 2612821.

2. Prati P,Vanuzzo D, Casaroli M, Di Chiara A, DeBiasi F, Feruglio GA, Touboul PJ. Prevalenceand determinants of carotid atherosclerosis

in a general population. Stroke, 1992,23:170511.PMID: 1448818.

3. Grafnetter D, Feruglio GA,Vanuzzo D. [Stan-dardization of the methods of lipid determi-nation according to WHO in the regionalproject of prevention of cardiovascular dis-eases in Friuli-Venezia Giulia.] Giornale Ital-iano di Cardiologia, 1996,26:28797. (Italian.)PMID:8690184.

4. Giampaoli S, Vanuzzo D. [Cardiovascular riskfactors in Italy: an interpretation with refer-ence to the National Health Plan 19982000.Research Group of the Cardiovascular Epi-demiologic Observatory.] Giornale Italiano diCardiologia,1999,29:146371.(Italian).PMID:10687109.

5. Giampaoli S,Panico S,Meli P, Conti S, Lo NoceC, Pilotto L, Vanuzzo D. [Cardiovascular riskfactors in women in menopause.] ItalianHeart Journal, 2000, 1(Suppl):11807.(Italian).PMID: 11140287.

6. Vanuzzo D,Pilotto L, Ambrosio GB,Pyorala K,Lehto S,De Bacquer D, De Backer G,Wood D.Potential for cholesterol lowering in second-ary prevention of coronary heart disease inEurope: findings from EUROASPIRE study.European Action on Secondary Preventionthrough Intervention to Reduce Events.Ath-erosclerosis. 2000, 153:50517. PMID:11164441.

7. Giampaoli S, Palmieri L, Dima F, Pilotto L,

Vescio MF, Vanuzzo D. [Socioeconomicaspects and cardiovascular risk factors:expe-rience at the Cardiovascular EpidemiologicObservatory.] Italian Heart Journal,2001, 2(Suppl):294302. (Italian). PMID:11307787.

8. Giampaoli S, Palmieri L, Pilotto L, Vanuzzo D.Incidence and prevalence of ischemic heartdisease in Italy: estimates from the MIAMODmethod. Italian Heart Journal, 2001,2:34955. PPMID: 1139263.

9. Giampaoli S, Palmieri L, Capocaccia R, PilottoL, Vanuzzo D. Estimating population-basedincidence and prevalence of major coronaryevents. International Journal of Epidemiology,2001, 30 Suppl 1:S510. PMID: 11759852.

10. Ferrario M, Cesana G, Vanuzzo D, Pilotto L,

Sega R, Chiodini P, Giampaoli S. Surveillanceof ischaemic heart disease: results from theItalian MONICA populations. InternationalJournal of Epidemiology 2001, 30 Suppl1:S239. PMID: 11759847.

Diego Vanuzzo, Lorenza Pilotto

MCC 32: MONICA-FriuliFive Reporting Units, merged into one RUA.

Administrative centreCentre for Cardiovascular Disease Prevention,A.S.S. 4 Medio Friuli, Agenzia Regionale della

Sanit,Udine, 33100,ItalyE-mail: [email protected]

T+

39 432 552 456; F+

39 432 552 452

PopulationResidents aged 2564 of three provinces of theFriuli-Venezia Giulia region of north-east Italy,bordering Austria and Slovenia. Mountainousnear the Alps in the north and flat near theAdriatic sea in the south, the area has a mixedeconomy and a total population in 1991 of940 000, including many elderly people. Thereare three urban centres. Udine with 100 000people is the largest. Living standards were poor,but are now fairly high. Cardiovascular diseaserates are high for Italy. The response rate tosurveys was over 75%.

FundingRegional Health Administration, CVD Registry.

DatesCoronary and stroke-event registration andcoronary care: 19841993. Population surveys:1986, 1989, 1994.

Additional descriptionEach resident has a unique personal identifierused to track cardiovascular events and deathsthrough computerized record linkage. Results ofthe population risk-factor surveys informedregional policies on prevention. Mortality rateshave declined in the last decade.

Local research interestsThe WHO-CCCCP Martignacco cohort, includinghaemostatic and homocysteine studies. WHO-CINDI Associate Member. Cardiovascular diseaseprevention. Event registration. Publication of adisease and risk-factor atlas.

Continuing activityFollow-up of MONICA survey cohorts with par-ticipation in the MORGAM and CUORE projects.


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MCC 45: KaunasSingle Reporting Unit.

Administrative centreInstitute of Cardiology of the Kaunas University

of Medicine,St Sukileliu 17, Kaunas LT-3007, LithuaniaT +370 7 73 2259; F +370 7 73 2286

PopulationResidents aged 2564 of the city of Kaunas, thesecond largest city in Lithuania,with a total pop-ulation in 1991 of 433 000. Kaunas is situated inthe centre of Lithuania, at the confluence of therivers Nemunas and Neris.Its main industries aretextiles and food processing. The city has eightuniversities and schools of higher education,and six hospitals. Mortality rates from the maincardiovascular diseases in Kaunas are similar tothose for Lithuania as a whole.

FundingMinistry of Education and Science.

DatesCoronary-event registration: 19831992. Coro-nary care: 19871992. Stroke-event registration:19861995. Population surveys: 1983/1984,1987, 1992/1993.

Additional descriptionEpidemiological studies of heart disease inKaunas, event registration and populationsurveys, were started in 1972 as part of themyocardial infarction register and the Kaunas-Rotterdam Intervention study (KRIS) coordi-nated by WHO. The latter study included onlymen. In Kaunas the KRIS study still continues asa cohort study. The Kaunas-MONICA study was

the first to include both sexes in risk factorsurveys, and it also initiated stroke registration.The main results of Kaunas-MONICA have been

used to prepare strategies for health promotionand prevention of non-communicable diseasesat local and national levels. Since 1994 mortalityrates from the main cardiovascular diseaseshave declined in Lithuania.

Local research interestsCoronary disease, stroke and risk factors inmiddle-aged men and women. Delivery of care.Diet and vitamins. Trends in cardiovascular dis-eases and risk factors.

Continuing activityCohort studies. Coronary and stroke-event reg-istration. Population surveys, using MONICAstandardization.

Key personnelPI: Juozas Bluzhas. Co-PI population surveys:Stase Domarkiene. Co-PI event registration:Daiva Rastenyte. Biochemist:Lil ija Margeviciene.

Other staff: Regina Reklaitiene, Abdonas Tamo-siunas, Dalia Rasteniene, Regina Grazuleviciene,Ricardas Radisauskas, Zita Petrokiene, ReginaGrybauskiene, Kristina Jureniene, DomaSidlauskiene.

Selected publications1. Rastenyte D, Salomaa V, Mustaniemi H,

Rasteniene D, Grazuleviciene R, Cepaitis Z,Kankaanpaa J, Kuulasmaa K, Torppa J,Bluzhas J, Tuomilehto J. Comparison oftrends in ischaemic heart disease betweenNorth Karelia, Finland,and Kaunas, Lithuaniafrom 1971 to 1987. British Heart Journal,1992, 68:516523.PMID: 1467041.

2. Rastenyte D, Cepaitis Z, Sarti C, Bluzhas J,Tuomilehto J. Epidemiology of Stroke inKaunas, Lithuania: first results from theKaunas stroke register. Stroke, 1995,26:240244. PMID:7831695.

3. Domarkiene S. [Ten year trends in the preva-lence of the main risk factors of ischaemicheart disease in the Kaunas population aged3564 years (the Kaunas MONICA study).]Medicina, 1995, 31:6165. (Li thuanian).PMID:na.

4. Petrokiene Z, Radisauskas R, Jureniene K.Acute coronary care and treatment inKaunas population during 19871993.Lithuanian Journal of Cardiology,1996,1:3642. PMID:na.

5. Rastenyte D, Tuomilehto J, Sarti C, Cepaitis Z,Bluzhas J. Trends in the incidence andmortality of stroke in Kaunas, Lithuania,19861993. Cerebrovascular Diseases, 1996,6:1320. PMID:na.

6. Rastenyte D, Tuomilehto J, Sarti C, Cepaitis Z,Bluzhas J.Increasing trends in mortality fromcerebral infarction and intracerebral haem-orrhage in Kaunas, Lithuania. Cerebrovascu-lar Diseases, 1996, 6:21621. PMID:na.

7. Bluzhas J, Radisauskas R, Rastenyte D,Rasteniene D,Grazuleviciene R,Petrokiene Z.[Morbidity and lethality from ischemic heartdisease in the Kaunas population during19711995.] Medicina, 1997, 33:2027.(Lithuanian). PMID:na.

8. Tamosiunas A, Jureniene K, Domarkiene S,Reklaitiene R. Prognostic value of behav-ioural risk factors for myocardial infarction

morbidity and mortality from differentcauses. Lithuanian Journal of Cardiology,1997, 4:26.PMID:na.

9. Domarkiene S,ed. [Epidemiology and preven-tion of cardiovascular diseases.].Kaunas,2000,234 p. (Lithuanian). PMID:na.

Juozas Bluzhas, Stase Domarkiene

#70 Lithuania-Kaunas (LTU-KAU, LT)

Juozhas Bluzhas

q first study of risk factors in Lithuania

that included women

q high cardiovascular mortality in both

sexesq data on disease and risk factors

informed national prevention

strategies Stase Domarkiene

Daiva Rastenyte

Institute


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MCC 33: AucklandSingle Reporting Unit.

Administrative centreDepartment of Community Health, University

of Auckland,Private Bag 92019, Auckland, New ZealandT +64 9 373 7599 x6335; F +64 9 373 7503

PopulationResidents in the Auckland area aged 3564.Auckland, with over a quarter of its population,is the largest city in New Zealand, situatedtowards the north of the North Island on anisthmus with harbours on both east and westcoasts. Maori, indigenous to New Zealand, aremore likely to live in Auckland than any othercity. It is called the Pacific Capital because it hasthe highest density of Pacific Islanders in theworld.The total population in 1991 was 951 000.

Funding1. Health Research Council of New Zealand. 2.National Heart Foundation of New Zealand.

DatesCoronary-event registration: 19831991(2)*.Coronary care: 1986, 1989, 1991. Populationsurveys: 1982, 1993/1994. (A survey was con-ducted in 1986/7 for a case-control study ratherthan for MONICA.) (*) = not included in MONICAcollaborative publications. No MONICA strokeregistration.

Additional descriptionIn 1981 a one-year register of coronary and

stroke patients known as ARCOS (AucklandRegion Coronary and Stroke Study) was estab-lished. This formed the background to the sub-sequent MONICA study. Auckland participatedthrough its stroke investigator, Ruth Bonita, inMONICAs stroke component, but not throughsubmitting data. Strokes were registered againin 1991 and a 16-year follow-up of the 1981cases has been completed. Population surveysexcluded Maoris as the sampling frame was thegeneral electoral roll and not the Maori only roll.Maori event rates were derived using censusdata.

Local research interestsTrends in coronary disease. Risk factors,particu-larly cholesterol.Long-term survival after a coro-nary event.Coronary disease in Maori and Pacificpeople.

Continuing activityCoronary-event registration has ceased. Afurther stroke register is planned, as is a fourthrisk factor survey.

Key personnelPI: Robert Beaglehole. CoPI: Rod Jackson. Bio-statistician: Alistair Stewart. CoInvestigator:Ruth Bonita

Selected publications1. Beaglehole R. Coronary heart disease trends

in Australia and New Zealand. InternationalJournal of Cardiology, 1989, 22:13.PMID:2784422.

2. Graham P, Jackson R, Beaglehole R, De BoerG. The validity of Maori mortality statistics.New Zealand Medical Journal, 1989,102:124126. PMID:2927807.

3. Hobbs M, Jamrozik K, Hockey R,Alexander H,Beaglehole R, Dobson A, Heller R, Jackson R,Stewart AW. Mortality from coronary heartdisease and incidence of acute myocardialinfarction in Auckland,Newcastle and Perth.Medical Journal of Australia, 1991,155:436442. PMID:1921812.

4. Lwel H, Dobson A, Keil U, Herman B,Hobbs MS, Stewart A, Arstila M, Miettinen H,Mustaniemi H, Tuomilehto J. Coronaryheart disease case fatality in four countries:a community study. C irculation, 1993,

88:25242531. PMID:8252663.5. Jackson R, Lay Yee R, Priest P, Shaw L,

Beaglehole R. Trends in coronary heartdisease risk factors in Auckland, 19821994.New Zealand Medical Journal, 1995,108:451454. PMID:8538961.

6. Bell C, Swinburn B, Stewart A, Jackson R,Tukuitonga C, Tipene-Leach D. Ethnic differ-ences and recent trends in coronary heartdisease incidence in New Zealand. NewZealand Medical Journal, 1996, 109:6668.PMID:8606820.

7. Trye P, Jackson R, Stewart A, Lay Yee R,Beaglehole R. Trends and determinants ofblood pressure in Auckland, New Zealand.19821994. New Zealand Medical Journal,

1996, 109:179181.PMID:8657382.8. Sonke GS,Beaglehole R,Stewart AW, Jackson

R, Stewart FM. Sex differences in case fatalitybefore and after admission to hospital afteracute cardiac events:analysis of community-based coronary heart disease register. BritishMedical Journal, 1996, 313:853855.PMID:8870571.

9. Beaglehole R, Stewart A, Jackson R, DobsonAJ, McElduff P, DEste K, Heller RF, JamrozikKD, Hobbs MS, Parsons R, Broadhurst R.Declining rates of coronary heart disease inNew Zealand and Australia 19831993.American Journal of Epidemiology, 1997,145:707713. PMID:9125997.

10. Stewart AW,Beaglehole R, Jackson R, BingleyW. Trends in three year survival followingacute myocardial infarction, 19831992.European Heart Journal, 1999, 20:803807.PMID:10329077.

Alistair Stewart


#71 New Zealand-Auckland (NEZ-AUC, NZ)

Robert Beaglehole and Ruth Bonita

q high coronary-event rates shown to be

declining

q improving prognosis in 28-day

coronary-event survivors

q decline in blood pressure 1982 to 1993

q studies of disease rates in those of

European,Maori and Pacific ethnicity

Stroke registration team

Auckland


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MCC 35: POL-MONICA KrakwTwo Reporting Units merged into one RUA.

Administrative centreDept of Epidemiology and Population Studies,

Institute of Public Health,Collegium Medicum, Jagiellonian University in

Krakw,St. Grzegrzecka,31-501 Krakw, PolandT +48 12 4241360; F +48 12 4217447Before 1992: Dept of Biochemical Diagnostics

and Inpatient Clinic for Metabolic Diseases,Nicolaus Copernicus Medical Academy inKrakw.

PopulationResidents aged 2564 of the south-eastern ruralprovince of Tarnobrzeg Voivodship. There is asteel industry in the south-east, while sulphurindustries (now diminished) dominated thecentre and north-west. Miners and industrialworkers often work smallholdings for agricul-tural produce as they live in villages and smalltowns.The total population in 1991 was 609 000.

Funding1. Ministry of Health. 2. National Committee forScientific Research contracts: 4 1474 91 1, 4PO5D 036 08.

DatesCoronary-event registration: 19841993. Coro-nary care: 198793. Population surveys:1983/84,1987/88, 1992/93. No stroke registration.

Additional descriptionTarnobrzeg Voivodship was chosen for POL-MONICA Krakow to contrast its rural populationand health care with that of Warsaw (see POL-

MONICA Warsaw). The Project also promotedcardiovascular disease prevention. Additionalsurvey data were used locally and for the Poland

and US Collaborative Study on Cardiopul-monary Epidemiology. MONICA monitored riskfactors and medical care and trends in coronaryheart disease mortality (which increased up to,and decreased after, 1992) during major politi-cal, economic and social changes.

Local research interestsPsychosocial and nutritional factors. Cognitiveimpairment in the elderly.Monitoring secondaryprevention.

Continuing activityEvent registration has ceased. Cohort studiesuntil 1998. Population survey in 2001.

Key personnelPI: Andrzej Pajak. Former PI(1990: Jan Sznajd.Staff: Ewa Kawalec, Roman Topr-Madry,Ewa Baczynska, Aleksander Celinski, HelenaCzarnecka, Alicja Hebda, Barbara Idzior-Walus,

Elz. bieta Kozek, Marzanna Magdon, Mal

gorzataMalczewska-Malec, Maciej Malecki, AdamMarkiewicz, Piotr Misiowiec, Ryszard Mizera,Ryszard Morawski, Witold Rostworowski, IwonaTrznadel-Morawska, Urszula Zeman, AndrzejZ.arnecki.

Selected publications1. Pajak A, Broda G, Abernathy JR, Sznajd J,

Rywik S, Irving SH, Czarnecka H,WagrowskaH,Thomas RP, Celinski A, et al. Poland-US col-laborative study on cardiovascular epidemi-ology: classification agreement between USNational Cholesterol Education Program andEuropean Atherosclerosis Society hyperlipi-

demia guidelines in selected Polish and USpopulations. Atherosclerosis, 1992, 95:4350.PMID:1642691.

2. Pajak A. [Myocardial infarction risks and pro-cedures.Longitudinal observational study in280 000 women and menPOL-MONICAKrakw Project. II. Risk factors and mortalitydue to ischaemic heart disease in men aged3564 years.] Przeglad Lekarski, 1996, 53,707712. (Polish).PMID:9173437.

3. Pajak A, Jamrozik K, Kawalec E, Topr-MadryR, Piko K,Malczewska-Malec M,Puchalska T.[Myocardial infarction risks and procedures.Longitudinal observational study in 280 000women and menPOL-MONICA KrakwProject. III. Epidemiology and treatment of

myocardial infarction.] Przeglad Lekarski,1996, 53, 767778. (Polish).PMID:3173437.

4. Pajak A. [Myocardial infarction risks and pro-cedures.Longitudinal observational study in280 000 women and menPOL-MONICAKrakw Project.IV. Prognosis in non-invasivetreatment in myocardial infarction within 28days from the onset.] Przeglad Lekarski,1996,53, 779784. (Polish).PMID:9173438.

5. Pajak A. [Myocardial infarction symptomsand procedures. Longitudinal observationof a study in 280000 women and menPOL-MONICA Krakw Project. V. Atypicalsymptoms and prognosis in myocardialinfarction.] Przeglad Lekars ki, 1996, 53,837841. (Polish).PMID:9163004.

6. Pajak A, Williams OD, Broda G, Baczynska E,Rywik S, Davis CE, Kawalec E, Chodkowska E,

Irving S, Manolio T. Changes over time inblood lipids and their correlates in Polishrural and urban populations: the Poland-United States Collaborative Study in car-diopulmonary disease epidemiology.Annals

of Epidemiology, 1997, 7:115124.PMID:9099399.

7. Pajak A, Broda G, Manolio TA, Kawalec E,Rywik S, Davis CE, Piko J, Pytlak A, ThomasRP. Constitutional, biochemical and lifestylecorrelates of fibrinogen and factor VII activ-ity in Polish urban and rural populations.International Journal of Epidemiology, 1998,27:953960. PMID:10024188.

8. Dennis BH, Pajak A, Pardo B, Davis CE,Williams OD, Piotrowski W. Weight gain andits correlates in Poland between 1983 and1993. International Journal of Obesity andRelated Metabolic Disorders, 2000,24:15071513. PMID:11126349.

Andrzej Pajak, Roman Topr-Madry

#72 Poland-Tarnobrzeg Voivodship (POL-TAR, PT)

Jan Sznajd (deceased)

q rural population posed challenges for

monitoring

q MONICA monitored rise and fall in

cardiovascular deathsq psychosocial and nutritional factors

q cognitive impairment in old age

Andrzej Pa jak

Baranow


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MCC 36: POL-MONICA-WarsawTwo Reporting Units merged as one ReportingUnit Aggregate (RUA).

Administrative centreDepartment of CVD Epidemiology and

Prevention,Stefan Cardinal Wyszynski National Institute of

Cardiology,04-628 Warszawa, Alpejska 42,PolandT +48 22 815 65 56; F +48 22 613 38 07

PopulationResidents aged 2564 of the two districts of thecapital city of Warsaw east of the Vistula.These

are partly industrial and partly residential andhome to hospitals, banks, governmental officesand universities. Polands changing economyhas affected the living conditions and behaviourof the population. In 1989/90 the free marketproduced mixed benefits: loss of State social

support, high inflation, high unemployment,but greater access to food products previouslyfound only in the western market. Risk-factorprofiles have changed. Cardiovascular diseasemortality, previously rising, began to decreasefrom 1991. The total population in 1991 was494000.

Funding1. Government Project: Prevention and Fightagainst Cardiovascular Disease. 2. State OfficeResearch Grant. 3. Ministry of Health.

DatesCoronary and stroke-event registration:

19841994. Coronary care: 19861994. Popula-tion surveys: 1984, 1988, 1993.

Additional descriptionThe population surveys included additionalfactors, including psychosocial factors, nutri-tion and drug use. Survey, coronary and stroke-registration results were published in databooks and used for the Poland-US CollaborativeStudy.

Local research interestsCohort study. Correlation of trends in psychoso-cial factors with mortality trends. Fibrinogen,Factor VII and other haemostatic factors. Nutri-

tional habits of the population and supplemen-tation with vitamins and minerals.

Continuing activityRegistration has ceased. Cohort studies contin-ued until 1998. A new population survey sam-pling the MONICA population aged 2074 tookplace in 2001.

Key personnelPI:Stefan L. Rywik.Co-PI:Graz

.yna Broda.Popula-

tion surveys: Henryka Wagrowska. Event-registration: Maria Polakowska, AleksandraPytlak. Biochemist: Ewa Chodkowska. Coopera-tion with MDC and statistical analyses: WitoldKupsc, Walerian Piotrowski, Pawel Kurjata,

Danuta Szczesniewska. Nutrition: Elz. bieta Syg-nowska, Anna Waskiewicz. Psychosocial: JerzyPiwonski.

Selected publications1. Broda G,Rywik S, Kurjata P.Trends in Myocar-

dial Incidence and Fatality in Warsaw Pol-MONICA population from 1984 to 1988.International Journal of Angiology, 1995,4:113116. PMID:na.

2. Broda G,Davis CE,Pajak A,Williams OD,RywikS, Baczynska E, Folsom AR, Szklo M. Polandand United States Collaborative Study onCardiopulmonary Epidemiology: A Compar-ison of HDL-cholesterol and its Subfractionsin Populations Covered by the United States

ARIC Study and the Pol-MONICA Project.Atherosclerosis, Thrombosis and VascularBiology, 1996, 16(2):339349. PMID:8620351.

3. Waskiewicz A, Sygnowska E, Broda G, PardoB. Dietary habits of the Warsaw populationobserved over 10 years within the frame-work of the Pol-MONICA Project. Nutrition,Metabolism and Cardiovascular Diseases,1997, 7:425431. PMID:na.

4. Rywik S, Davis CE, Pajak A, Broda G, FolsomAR, Kawalec E, Williams OD. Poland and USCollaborative Study on cardiovascular epi-demiology: Hypertension in the commu-nityprevalence, awareness, treatment andcontrol of hypertension in the Pol-MONICA

Project and US ARIC Study. Annals of Epi-demiology, 1998, 8:313. PMID:9465988.5. Abernathy JR, Rywik S, Pajak A, Thomas RP,

Broda G, Kawalec E. Correlates of total andCVD mortality in US and Polish men andwomen aged 3564 years. CardiovascularDisease Prevention, 1998, 1:2531. PMID:na.

6. Rosamond S, Broda G, Kawalec E, Rywik S,Pajak A, Cooper L, Chambless L. Comparisonof medical care and survival of hospitalizedpatients with acute myocardial infarction inPoland and the United States. AmericanJournal of Cardiology, 1999, 83:11801185.PMID:10215280.

7. Broda G, Davis CE,Pajak A, Rywik S, Irving SH,Kennedy JI, Topr-Madry R. 10-year trends in

cigarette smoking in Polish urban and ruralpopulations in the Pol-MONICA Project.Cardiovascular Disease Prevention, 1999,5:945954. PMID:na.

8. Pytlak A, Piotrowski W. Prognostic signifi-cance of Q-Tc interval for predicting total,cardiac and ischemic heart disease mortalityin community-based cohort from Pol-MONICA population. Annals of NoninvasiveElectrocardiology, 2000, 5:322329. PMID:na.

9. Broda G. Isolated systolic hypertension is astrong predictor of cardiovascular and all-cause mortality in the middle-aged popula-tion: Warsaw Pol-MONICA Follow-up Project.Journal of Clinical Hypertension (GreenwichConn.), 2000, 2, 305311. PMID:11416666.

10. Rywik SL,Williams OD,Pajak A, Broda G,DavisCE, Kawalec E, Manolio TA, Piotrowski W,Hutchinson R. Incidence and correlates ofhypertension in the ARIC Study and thePol-MONICA project. Hypertension, 2000,18:9991006. PMID:10953989.

Stefan Rywik


#73 Poland-Warsaw (POL-WAR, PW)

Stefan Rywik

q high initial all-cause mortality, but

improving

q high initial case fatality for stroke, but

improvingq smoking and blood pressure both

high, but not cholesterol

q participated in Poland-United States

studies


8/19


MCC 46: Moscow

Three Reporting Units amalgamated into eithertwo (Russia-Moscow Control, and Russia-Moscow Intervention) or one Reporting UnitAggregate (Russia-Moscow). In MONICA collab-orative analyses RUS-MOS contains all threeReporting Units for coronary care. RUS-MOCcovers only the Octyabrsky district. RUS-MOI hastwo variants: it included the Cheremushkinskydistrict for coronary eventsMOIb, but for risk-factor surveys and stroke covered only theLeninsky districtMOIa.

Administrative centreState Research Centre for Preventive Medicine,10 Petroverigsky Lane,Moscow 101990, Russian Federation

T/F +7 095 925 45 44E-mail: [email protected], [email protected]

PopulationResidents aged 2564 of the Octyabrsky (RUS-MOC), Leninsky and Cheremushkinsky (RUS-MOI) districts of Moscow. Lifestyle andrisk-factor levels typical of megapolisand Russian towns with high mortality andmorbidity rates. The total population in 1991was 214000 (Moscow-Control) and 601000(Moscow-Intervention, MOIb).

FundingBudget of the Russian Federation.

DatesCoronary-event registration: 198593. Coronarycare: 1986, 198993. Stroke-event registration:198593. Population surveys: 198486,1988/89*, 199295*. (* = middle and finalsurveys were not carried out in Cheremushkin-sky district.)

Additional descriptionIn two districts, Leninsky and Cheremushkinsky,mass redevelopment occurred during theperiod 19841987; many families moved out ofthis area into new homes elsewhere. Thischanged the demographic profile of these dis-tricts, especially of the smaller Leninsky.

Local Research InterestsMonitoring of main risk factors and mortality inthe frame of possible prevention activities atlocal level.

Continuing activityMortality follow-up under development. In20002001 MONICA-4 took place in theOctyabrsky district,including 424 males and 386females aged 2564.

Key personnel*PI 19972001: Georgy Zhukovsky. Former PI198386: Sergei Fedotov. Former PI 198697:Tatyana Varlamova. Other staff: A Britov,T Timo-feeva, M Osokina, A Alexandri, N Serdyuchenko,V Naumova, N Popova, A Kapustina.*New team from 2001:PI: Vladimir Konstantinov.Co-PIs: Svetlana Shalnova, Alexander Deev.

Selected publications1. Volozh OI, Solodkaia ES, Mutso IuKh,

Zhukovskii GS, Varlamova TA. [Comparisonof the inference of the existence ofischaemic heart disease in epidemiologicalresearch with prior polyclinical diagnosis.]Kardiologiia, 1985, 25:9899. (Russian).PMID:3990090.

2. Gorbunov AP, Zhukovskii GS, Nebeiridze DV,Varlamova TA, Oganov RG. [Potentialischaemic heart disease and mortality in themale population 4059 years old over 6.5years of observation.] Kardiologiia, 1987,27:3943. (Russian). PMID:3695111.

3. Varlamova T, Zhukovski G, Chazova L, BritovA. Monitoring of major cardiovascular dis-eases in Moscow, USSR.Acta Medica Scandi-navica Supplementum, 1988, 728:7378.PMID:na

4. Shalnova SA, Maksimov AB, Kapustina AV,Zhukovskii GS, Varlamova TA.[Prognostic sig-nificance of different variants of chest pain inmen aged 4049 years (data of a prospectivestudy).] Terapevticheskii Arkhiv, 1988,60:3035. (Russian). PMID:3363504.

5. Oganov RG, Zhukovskii GS, Fedin AI,Varlamova TA, Migirov AA. [Morbidity andmortality from stroke among the populationof Moscow.] Terapevticheskii Arkhiv, 1989,61:2932. (Russian). PMID:2595580.

6. Britov A,Varlamova T, Kalinina A,OstrovskayaT,Konstantinov V, Konstantinov E, Nikulina L,Elisseeva N, Sapozhnikov I. Hypertensionstudies in the Soviet Union. Clinical andExperimental Hypertension.Part A,Theory and

Practice, 1989, 11:841858. PMID:2676258.7. Britov AN, Zhukovskii GS, Sviderskii VG,

Varlamova TA, Liubimova LV, Naumova VV,Deev AD, Spizhovyi VN, Adonev BI,Grishenko EA et al. [The results of conduct-ing a programme for the supplementaryeducation of medical workers in the prob-lems of preventing and treating arterial

hypertension (a population study).] Kardi-ologiia, 1992, 32:6873. (Russian).PMID:1487887.

This page was drafted during a break in com-munication between Moscow and MONICA, butlater modified and approved.

Vladislav Moltchanov,Hugh Tunstall-Pedoe,Svetlana Shalnova

#74 Russia-Moscow (RUS-MOS, RM)

St Basils Cathedral

q results from Moscow during a decade

of changeq case fatality for coronary events

increased

q fall in blood pressure,cholesterol and

body mass index (BMI)

q Moscow districts divided into two

RUAs

q populations differed for risk-factor and

event monitoring

Russian dolls

Russia-Moscow Control (RUS-MOC, RC)Russia-Moscow Intervention (RUS-MOI, RI)


9/19

MCC 47: Siberian MONICAThree Reporting Units. RUS-NOI covered onlythe Octyabrsky district. RUS-NOC included boththe Kirovsky and Leninsky districts for coronaryevents and stroke (NOCb), and the baselinesurvey. For the middle and final risk-factorsurveys it covered the Kirowsky district aloneNOCa. All three Reporting Units (districts) aregrouped together in RUS-NOV for analyses of

coronary care and for Monograph map graphics.

Administrative centreInstitute of Internal Medicine,Siberian Branch

of Russian Academy of Medical Science,Vladimirovsky spusk 2a, Novosibirsk 630003,

Russian FederationT +7 38 3229 2048; F +7 38 3222 2821

PopulationResidents aged 2564 of the city of Novosibirsk,central West Siberia, the industrial and scientificcentre of Siberia. Coronary heart disease andstroke morbidity and mortality rates are high inmen and women. The total population in 1991

was 482 000 (Novosibirsk Control, NOCb) and160 000 (Novosibirsk Intervention).

FundingRussian Academy of Medical Science.

DatesTechnical problems affected collaborative analy-sis of some of the material collected. In collabo-rative MONICA trend analyses (as distinct fromlocal use) the following dates apply:RUS-NOC: Coronary-event registration: 19841992 (1993 omitted). Coronary care; 19861987,19891993. Stroke registration: 19871993(early years and 1994 omitted). Populationsurveys: 1985/1986, 1988/1989, 1995.RUS-NOI: Coronary-event registration: 19841993.Coronary care:1986/1987,19891993.Strokeevent registration: 19821993 (1994 omitted).Population surveys:1985, 1988, 1994/1995.

Additional descriptionPopulation surveys followed the MONICA proto-col but with some additional items added. Thehigh cardiovascular mortality in Novosibirskincreased dramatically at the beginning of the1990s but declined modestly after 1994.

Local research interestsParadoxical trends of all-cause and cardiovascu-lar diseases mortality in the target population.Comparison of classic with novel risk factors(psychosocial factors, diet, alcohol). Populationgenetics of cardiovascular diseases.

Continuing activityCoronary-event registration continues. Stroke-event registration continues in two districts. Arepeat population survey of the 4564 agegroup was conducted in 1999/2000. Cohortstudies continue.

Key personnelPI:Yuri Nikitin.Other staff:Sofia Malyutina,ValeryGafarov, Valery Feigin, Galina Simonova,TatyanaVinogradova.

Selected publications1. Nikitin YP, Shalaurova IY, Serova NV. The vali-

dation of serum thiocyanate smoking data ina population survey. Revue dEpidmiologieet de Sant Publique, 1990, 38:469472.PMID:2082453.

2. Nikitin YP, Mamleeva FR,Efendieva DB. Nutri-tion and cardiovascular disease in SiberianResidents.Journal of Progress in Cardiovascu-lar Science, 1993, I:127133. PMID:na.

3. Nikitin Y, Malyutina S,Tikhonov A.Lipid spec-trum and antioxidant vitamins in urbanSiberian population. Acta Cardiologia, 1994,49:400402. (Conference abstract). PMID:7976064.

4. Feigin VL, Wiebers DO, Nikitin YP, OFallonWM, Whisnant JP. Stroke epidemiology inNovosibirsk, Russia: A population-basedstudy. Mayo Clinic Proceedings, 1995,70:847852. PMID:7643638.

5. Feigin VL, Wiebers DO,Whisnant YP, OFallonWM. Stroke incidence and 30-day case-fatality rates in Novosibirsk, Russia, 1982through 1992. Stroke, 1995, 26:924929.PMID:7762039.

6. Stegmayr B, Vinogradova T, Malyutina S,

Peltonen M, Nikitin Y, Asplund K. Wideninggap of stroke between east and west. Eight-year trends in occurrence and risk factors inRussia and Sweden. Stroke, 2000, 31: 28.PMID:10625707.

7. Gafarov VV. [20 year monitoring of acutecardiovascular disease in the population ofa large industrial city in the West Siberia(an Epidemiological Study).] TerapevticheskiiArkhiv, 2000, 1:1521. (Russian. Englishabstract). PMID:10687199.

8. Nikitin YP, Kazeka LR, Babin VL, Malyutina SK.[Prevalence of Ischemic Heart Disease inSubjects with Hyperinsulinemia (A Popula-tion Study).] Kardiologiia, 2001, 1:1216.(Russian. English abstract). PMID:na.

9. Malyutina S, Simonova G, Nikitin YP. Theincidence of coronary heart disease and car-diovascular mortality in the urban Siberian

population: gender-specific findings fromthe 10-year cohort study. In: Weidner G. et al,eds. Heart Disease: Environment, Stress andGender, NATO Science Series, 2000, vol.327.ISBN 1 58603 082 5. PMID:na.

Yuri Nikitin, Sofia Malyutina


#75 Russia-Novosibirsk (RUS-NOV, RN)

Yuri Nikitin

q very high all-causes and

cardiovascular mortality

q overall increase in coronary-event

rates

q highest stroke event rates in MONICAq high smoking rates in men and body

mass index in women

Russia-Novosibirk Control (RUS-NOC, RO)Russia-Novosibirk Intervention (RUS-NOI,RT )

Sofia Malyutina

Institute

River Ob


10/19


MCC 39: MONICA-CataloniaTwo areas now counted as one Reporting Unit.

Administrative centrePrograma CRONICAT,Hospital de la Santa Creu i Sant Pau,P. Claret 167, Barcelona 08025, SpainT +34 93 456 3612; F +34 93 433 1572

PopulationResidents aged 2574 of five counties in themetropolitan area of Barcelona, extending fromthe northern limit of the city towards the Pyre-nees. One of the most industrialized areas inSpain, with a minor agricultural sector, it hasseveral hospitals and a university providing acomprehensive health service. Half the popula-tion comes from other Spanish regions. Highunemployment rates improved during the studyperiod as did socioeconomic development.Response rates for surveys were high. Cardio-vascular mortality rates were similar to theSpanish average. The total population in 1991was 1 119000.

Funding1. Institute of Health Studies, Department ofHealth and Social Security,Generalitat of Catalo-nia. 2. Manresa Savings Bank. 3. Hospital de laSanta Creu i Sant Pau.

DatesCoronary-event registration; 198594. Coronarycare: 198687, 198994. Population sur-

veys: 198688, 199092, 199496. No strokeregistration.

Additional descriptionEstablished to evaluate the CRONICAT Pro-gramme for the community control of chronicdiseases, MONICA-Catalonia originally plannedto monitor two areas. However a change of planled to one single study area. Population surveysincluded 8990 men and women and additionalitems. MONICA-Catalonia confirmed the lowincidence of coronary heart disease shownin mortality statistics, achieved good qualityscores, and is the model for other surveys andregisters in Spain. Outside the former Easternbloc centres of Asia,central and eastern Europe,Catalonia was the only MONICA population tosee coronary-event rates increasingbut from avery low level.

Local research interestsCoronary disease and risk factors in women.Obesity,diabetes,nutrition,psychosocial factors.Risk assessment. Delivery of care. Ageing. Epi-

demiological surveillance methods.

Continuing activityRegistration continued until 1998. Popula-tion surveys have ceased. Cohort studies areongoing.

Key PersonnelPI: Susana Sans. Former CoPI 198493:Ignacio Balaguer-Vintr. Biochemistry: FrancescGonzlez Sastre. Former key staff: Llusa Bala,Anna Puigdefbregas, Guillermo Paluzie.

Selected publicationsComprehensive list available on request

1. Balaguer-Vintr I, Sans S. Coronary heartdisease mortality trends and related factorsin Spain. Cardiology, 1985, 72:97104.PMID:3872179.

2. Sans S, Balaguer-Vintr I,Fornells J, Borrs J,Mndez E. CRONICAT Programme: reviewof three years experience in a communitychronic diseases prevention programme inSpain. In:Chazov E,Oganov RG,Perova N andV. Preventive Cardiology. London: HarwoodAcademic Publishers,1985: 481485. ISBN 3-7186-0338-I.

3. Rods A,Sans S,Bala Ll,Paluzie G,AguileraR, Balaguer-Vintr I. Recruitment methodsand differences in early, late and non-respondents in the first MONICA-CATALONIA

population survey. Revue dEpidmiologieet de Sant Publique, 1990, 38:447453.PMID:2082450.

4. Paluzie G, Sans S, Bala L,Balaguer-Vintro I.Random zero versus standard sphygmo-manometer (extended abstract).Acta Cardi-ologica, 1994, 64:327329. PMID:7976064.

5. Sans S,Kesteloot H, Kromhout D,on behalf ofthe Task Force. The burden of cardiovasculardiseases mortality in Europe. Erratum in:European Heart Journal, 1997,18:16801681.European Heart Journal, 1997,18:12311248.PMID: 9508543.

6. Sans S. Does change in serum cholesterol ofa population influence coronary heartdisease mortality? (Editorial). European HeartJournal, 1997, 18:540543.PMID 9129876.

7. Sans S, Puigdefbregas A, Paluzie G. Acutemyocardial infarction is increasing in

Spanish men. European Heart Journal, 1999,20 Abstr supl 1:472472. PMID:10513291.

8. Sans S, Paluzie G, Puigdefbregas A. Trendsof coronary heart disease in Catalonia,198597: MONICA project. Butllet Epidemi-olgic de Catalunya 2000, XXI (extraordinari1r trimestre):6167. (Catalan). ISSN 0211-6340. PMID:na. URL: http://www.gencat.es/sanitat/portal/cat/spbec.htm.

9. Paluzie G,Sans S,Bala L, Puig T, Gonzlez-Sastre F, Balaguer-Vintr I. Secular trendsin smoking according to educationallevel between 1986 and 1996: the MONICAStudy-Catalonia. Gaceta Sanitaria, 2001,117:303311. (Spanish, English abstract).PMID:11578559.

10. Sans S, Paluzie G, Bala L, Puig T, Balaguer-Vintr I. Trends in prevalence, awareness,treatment and control of arterial hyperten-sion between 1986 and 1996: the MONICA-Catalonia study (Erratum in: Medicina Clnica(Barc), 2001,117:731).Medicina Clnica (Barc),2001, 117:246253. (Spanish, English

abstract). PMID:11562326.

Susana Sans,Ignacio Balaguer-Vintr

#76 Spain-Catalonia (SPA-CAT, SP)

Susana Sans

q the only MONICA population in Spain

q Mediterranean population, high

smoking,low coronary rates butincreasing

q research on coronary disease in

women and the elderly

q obesity, diabetes, nutrition,

psychosocial factors

q hosted 7th Council of Principal

Investigators, August 1992 Ignacio Balaguer-Vintr

Barcelona


11/19

men born in 1913,1923, 1933 and 1943;on menaged 4755 born in 19151925 (excluding1923). Samples were examined in 19701973,19741977 and 1980.Screening was also carriedout on women aged 3564 in 1980 and onwomen aged 5584 in 1997. Serum cholesterol,

smoking and blood pressure as well as coronary-event rates and mortality have all declined overthis period.

Continuing activityPopulation screening continues, but registrationof events via hospital records is now carried outnationally.

Key personnelPI: Lars Wilhelmsen. CoPI: Annika Rosengren.Other staff: Saga Johansson, Per Harmsen(stroke). Statistician: Georg Lappas.

Selected publications

1. Harmsen P, Tsipogianni A, Wilhelmsen L.Stroke incidence rates were unchangedwhile fatality rates declined, during 19711987 in Gteborg, Sweden. Stroke, 1992,23:14101415. PMID:1412576.

2. Landin-Wilhelmsen K,Wilhelmsen L,Wilske J,Lappas G,Rosn T,Lindstedt G, Lundberg PA,Bengtsson B-A. Sunlight increases serum 25(OH) vitamin D concentration, whereas1,25(OH)2D3 is unaffected. Results from ageneral population study in Gothenburg,Sweden (the WHO MONICA Project).European Journal of Clinical Nutrition, 1995,49:400407. PMID:7656883.

3. Wilhelmsen L, Rosengren A, Johansson S,Lappas G.Coronary heart disease attack rate,incidence and mortality 19751994 inGteborg, Sweden. European Heart Journal,1997, 18:572581.PMID:9129885.

4. Wilhelmsen L, Johansson S, Rosengren A,Wallin I,Dotevall A, Lappas G.Risk factors forcardiovascular disease during 19851995in Gteborg, Sweden. The GOTMONICAProject. Journal of Internal Medicine, 1997,42:199211. PMID:9350164.

5. Wilhelmsen L. Cardiovascular monitoringof a city during 30 years, ESC populationstudies lecture for 1996. European HeartJournal, 1997, 18:12201230. PMID:9458414.

6. Wilhelmsen L, Rosengren A, Lappas G.Relative importance of improved hospital

treatment and primary prevention. Resultsfrom 20 years of the Myocardial InfarctionRegister in Gteborg, Sweden. Journal ofInternal Medicine, 1999, 245:185191. PMID:10081521.

7. Rosengren A, Stegmayr B, Johansson I, Huh-tasaari F, Wilhelmsen L. Coronary risk factors,diet and vitamins as possible explanatoryfactors of the Swedish north-south gradientin coronary disease: a comparison of twoMONICA centres.Journal of Internal Medicine,1999, 246:577586.PMID:10620101.

8. Rosengren A, Eriksson H, Larsson B,Svrdsudd K, Tibblin G, Welin L, WilhelmsenL. Secular changes in cardiovascular riskfactors over 30 years in Swedish men aged

50:the study of men born in 1913,1923,1933and 1943.Journal of Internal Medicine, 2000,247:111118. PMID:10672138.

9. Dotevall A, Rosengren A, Lappas G,Wilhelmsen L. Does immigration contributeto decreasing CHD incidence? Coronary riskfactors among immigrants in Gteborg,Sweden. Journal of Internal Medicine, 2000,247:331339. PMID:10762449.

10. Manhem K, Dotevall A, Wilhelmsen L,Rosengren A. Social gradients in cardiovas-cular risk factors and symptoms of Swedishmen and women: The Gteborg MONICAstudy 1995. Journal of Cardiovascular Risk,2000, 7:359368. PMID:11143766.

Lars Wilhelmsen


#77 Sweden-Gothenburg (SWE-GOT, SG)

Anna Rosengren

q Gothenburg population has

contributed much to cardiovascular

epidemiology

q low all-causes mortality, coronary andstroke rates

q changes in event rates in the mid-

range

q good improvements in risk factors

q results contrast with those from

Northern Sweden

Lars Wilhelmsen

George Lappas

MCC 40:GOT-MONICASingle Reporting Unit.

Administrative centreSection of Preventive Cardiology,Institute of Cardiovascular Diseases,Gteborg

University,Drakegatan 6, SE41250 Gteborg, SwedenT +46 31 703 1884; F +46 31 703 1890The base for coronary and stroke registers and

for population surveys was SahlgrenskaUniversity Hospital, Gteborg.

PopulationResidents aged 2564 of the city of Gteborg(Gothenburg), in the south-west of Sweden. It isSwedens largest port. Industries include carmanufacturing, space and information technol-ogy and several universities. Immigrants make

up 17% of the population. They suffer highunemployment rates. In addition, there aresocial and health-related differences within thecity.The total population in 1991 was 433 000.

Funding1. Swedish Medical Research Council. 2. SwedishHeart and Lung Foundation.3.The Inga-Britt andArne Lundberg Foundation.

DatesCoronary and stroke-event registration:19841994. Coronary care: 19861987 and19911992. Population surveys: 1985/1986,1990/1991, 19941996.

Additional descriptionScreening of random population sampleshas been carried out since 1963 on 50-year old


12/19


MCC 60: Northern SwedenTwo Reporting Units merged into one ReportingUnit Aggregate (RUA).

Administrative centres

MONICA Secretariat, Department of Medicine,University Hospital, SE-901 85 Umea, SwedenandMONICA Secretariat, Kalix Hospital, SE952 82

Kalix,SwedenT +46 90 785 2518 or +46 92 31 3133 ; F +46 90

13 7633E-mail: [email protected] and

[email protected]

PopulationResidents aged 2564 (for coronary events),2574 (for strokes and risk-factor surveys) of theNorrbotten and Vasterbotten counties in thenorth of Sweden. Income and employment inthese counties are below average. The peopleare of south Scandinavian, Saamish and Finnishethnicity. Skiing, hiking, fishing and huntingduring long summer days and winter nights.There are nine acute hospitals. Participation inpopulation surveys was high. The total popula-tion in 1991 was 518 000.

Funding1. Swedish Medical Research Council. 2. Heartand Chest Fund.3. Vasterbotten and NorrbottenCounty Councils. 4. King Gustaf V and QueenVictorias Foundation. 5. Swedish Public HealthInstitute.

DatesCoronary-event registration: 19851995. Coro-nary care: 19861987, 19891995. Stroke-eventregistration: 198594. Population surveys: 1986,1990, 1994.

Additional descriptionExcess cholesterol levels fell with the adoptionof a pasta-type food culture. Smoking ratesextremely low in men but many use smokelesstobacco. The huge decline in male coronarydeaths resulted both from declining case fatal-ity and event rates. Coronary-event rates inwomen and stroke rates were stable. MONICAhelped build a biobank of frozen material from85 000 people with record-linkage for events.

Local research interestsSocial and sex differences in risk factors andevents.Smokeless tobacco,diabetes and the fib-rinolytic system as risk factors.Long-term strokeepidemiology. Gene-environment interactionsin cardiovascular disease.

Continuing activityCoronary and stroke event registration continuewith extended coronary age-group. Population

survey in 1999 included re-examination of the198694 survey subjects.Use of MONICA data inthe GENOS Project (Gene-Environment Interac-tions in Northern Sweden) and MORGAMcollaboration.

Key personnelPIs 1994: Kjell Asplund, 2000: TorbjornMessner. Former PIs 198494: Per-Olov Wester,19842000: Fritz Huhtasaari. Other staff, event-registration and population surveys: BirgittaStegmayr, Vivan Lundberg, Elsy Jagare-Westerberg,Gunborg Ronnberg, Asa Johansson.

Selected publications

Full list available from the MONICA Secretariat,Umea. Northern Sweden MONICA Project fea-tures in Scandinavian Journal of Public Health,2002, Supplement.1. Peltonen M, Lundberg V, Huhtasaari F,

Asplund K. Marked improvement in survivalafter acute myocardial infarction in middle-aged men but not in women. The NorthernSweden MONICA Study 19851994. Journalof Internal Medicine, 2000, 247:579587.PMID:10809997.

2. Peltonen M, Asplund K, Rosn M. Social pat-terning of myocardial infarction and strokein Sweden: incidence and survival.AmericanJournal of Epidemiology, 2000, 151:283292.PMID: n/a.

3. Stegmayr B, Vinogradova T, Malyutina S,Peltonen M, Nikitin Y, Asplund K. Wideninggap of stroke between east and west. Eight-year trends in occurrence and risk factors inRussia and Sweden. Stroke, 2000, 31:28.PMID:10625707.

4. Johansson L, Jansson JH, Boman K, NilssonTK, Stegmayr B, Hallmans G. Tissue plas-minogen activator, plasminogen activatorinhibitor-1, and tissue plasminogenactivator/plasminogen activator inhibitor-1complex as risk factors for the developmentof a first stroke. S troke, 2000, 31: 2632.PMID:10625711.

5. Ohgren B,Weinehall L,Stegmayr B,Boman K,Hallmans G,Wall S. What else adds to hyper-tension in predicting stroke? Journal ofInternal Medicine, 2000, 248:47582. PMID:11155140.

6. Rask E, Olsson T, Soderberg S, Andrew R,Livingstone DE, Johnson O, Walker BR.Tissue-specific dysregulation of cortisolmetabolism in human obesity. Journal ofClinical Endocrinology and Metabolism, 2001,86:141821. PMID: 11238541.

7. Nilsson M, Trehn G, Asplund K. Use of com-plementary and alternative medicine reme-dies in Sweden. Journal of Internal Medicine,2001, 250:22533. PMID: 11555127.

8. Soderberg S,Ahren B, Eliasson M,Dinesen B,

Brismar K, Olsson T. Circulating IGF bindingprotein-1 is inversely associated with leptinin non-obese men and obese post-menopausal women. European Journal ofEndocrinology, 2001, 144:28390. PMID:11248749.

9. Lundberg V,Wikstrom B, Bostrom S, AsplundK. Exploring sex differences in case fatalityin acute myocardial infarction or coronarydeath events in the Northern SwedenMONICA Project.Journal of Internal Medicine,2002, 251:23544. PMID: 11886483.

10. Persson M,Carlberg B,Mjorndal T, Asplund K,Bohlin J, Lindholm L. 1999 WHO/ISH Guide-lines applied to a 1999 MONICA sample from

northern Sweden. Journal of Hypertension,2002, 20:2935. PMID:11791023.

Kjell Asplund

#78 Sweden-Northern Sweden (SWE-NSW, SN)

Survey team

q MONICA crossing the Arctic Circle

q event rates much higher than

southern Sweden (see Gothenburg)

q biggest reduction in coronary deathsin men

q highest treatment score for coronary

events

q score for risk-factor change in mid-

range

Kjell Asplund

Reindeer on the road


13/19

MCC 50: MONICA SwitzerlandTwo distinct Reporting Units merged forcoronary care.

Administrative centre

Institut universitaire de mdecine sociale etprventive,rue du Bugnon, 17, 1005 Lausanne, SwitzerlandT +41 21 314 72 72; F +41 21 314 73 73.

PopulationResidents aged 2574 of the French-speakingcantons of Vaud and Fribourg, and the Italian-speaking canton of Ticino.They are both mixedurban and rural communities but had the lowestand highest mortality from coronary heartdisease in Switzerland. Women were excludedfrom event-registration because projectednumbers of female events were considered toolow for estimating trends. The total populationof Vaud-Fribourg in 1991 was 791 000, and of

Ticino was 288 000.

Funding1. Swiss National Science Foundation (grantnumbers 3.8560.83, 3.938.0.85, 329271.87,3230110.90). 2. Canton of Vaud. 3. Canton ofTicino.

DatesCoronary-event registration: 19851993*.Coronary care: 1986, 1990,1992/93*. Populationsurveys: 198486, 1988/89, 1992/93. No strokeregistration.*Men only.

Additional description

A community programme for primary preven-tion of coronary heart disease was launched inTicino in 1984. The evaluation used the resultsof the three MONICA population surveys,with Vaud-Fribourg acting as the control com-parator region.The surveys inspired opportunis-tic studies such as a study of the decline in bloodlead as the use of unleaded petrol increased;andmonitoring of physical activity over a one-weekperiod using a pedometer. MONICA serum isbeing used extensively as an archive of refer-ence values for Switzerland, for example ofserum 25Hydoxyvitamin D, serum lipopro-tein(a), and antibodies to the herpes simplexvirus.

Local research interestsAssociation between blood lipids and obesity.Epidemiological transition (comparison with theSeychelles Heart Study).Diffusion of health tech-nology in coronary care.

Continuing activityAll activities have ceased but coronary-eventregistration using a coronary-care survey isplanned for a one-year period in the near future.

Key personnelInitiators:Felix Gutzwiller (PI, moved to Zurich in1988), Gianfranco Domenighetti (Ticino). Co-ordinator 1988: Fred Paccaud. MedicalOfficers: Martin Rickenbach ( VaudFribourg),Fabrizio Barazzoni (Ticino). Statistician: VincentWietlisbach.

Selected publications1. Rickenbach M, Wietlisbach V, Beretta-Piccoli

C, Moccetti T, Gutzwiller F. [Smoking, bloodpressure and body weight in the Swisspopulation. MONICA study 198889.]Schweizerische Medizinische Wochenschrift

Supplementum, 1993, 48:2128. (German).PMID:8446868.

2. Burnand B, Wietlisbach V, Riesen W, NosedaG, Barazzoni F, Rickenbach M, Gutzwiller F.[Blood lipids in the Swiss population.MONICA study 198889.] SchweizerischeMedizinische Wochenschrift Supplementum,1993, 48:2937. (French).PMID:8446869.

3. Sequeira MM, Rickenbach M, Wietlisbach V,Tullen B, Schutz Y. Physical activity assess-ment using a pedometer and its comparisonwith a questionnaire in a large populationsurvey. American Journal of Epidemiology,1995, 142:989999.PMID:7572981.

4. Wietlisbach V, Paccaud F, Rickenbach M,Gutzwiller F. Trends in cardiovascular riskfactors (19841993) in a Swiss region:resultsof three population surveys. Preventive Med-icine, 1997, 26:523533.PMID:9245675.

5. Bourquin MG, Wietlisbach V, Rickenbach M,Perret F, Paccaud F. Time trends in the treat-ment of acute myocardial infarction inSwitzerland from 1986 to 1993: do theyreflect the advances in scientific evidencefrom clinical trials? Journal of Clinical Epi-demiology,1998,51:723732.PMID:9731920.

6. Paccaud F, Schlter-Fasmeyer V, WietlisbachV, Bovet P. Dyslipidemia and abdominalobesity: an assessment in three generalpopulations.Journal of Clinical Epidemiology,2000, 53:393400. PMID:10785570.

Vincent Wietlisbach


#79 Switzerland (SWI-SWI, SW)

VAF

TIC

Felix Gutzwiller

q low event rates despite high total

cholesterol levels

q no coronary-event registration in

women

q included the 6574 age group

q hosted 6th Council of Principal

Investigators, Lugano,April 1990

Vincent Wietlisbach and Martin Rickenbach

Switzerland-Vaud/Fribourg (SWI-VAF, SV)Switzerland-Ticino (SWI-TI, ST)


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MCC 34: BelfastSingle Reporting Unit.

Administrative centreDepartment of Epidemiology and Public

Health (formerly Community Medicine),

Mulhouse Building, Queens University Belfast,Grosvenor Road, Belfast, BT12 6BJ, Northern

Ireland, United KingdomT +44 28 9023 7153; F +44 28 9023 6298Coordinating centre for the MONICA Optional

Study on Haemostatic Factors, and antioxi-dant studies. Registration centre was in theRoyal Victoria Hospital.

PopulationResidents aged 2564 of Belfast city and theCastlereagh, North Down and Ards health dis-tricts in Counties Antrim and Down. MONICAcovered one-third of the Provinces population.Approximately 60% were Belfast city dwellers.Shipbuilding, engineering and textiles are indecline. Dairy farming dominates rural areas.MONICA took place against a backdrop of sec-tarian strife,now thankfully reduced,in commonwith a once very high coronary mortality. Thetotal population in 1991 was 477000.

Funding1. Medical Research Council (UK). 2. Departmentof Health and Social Services (NI). 3. NorthernIreland Chest Heart and Stroke Association. 4.British Heart Foundation.

DatesCoronary-event registration:19831993.Popula-tion surveys: 1983/1984, 1986/1987, 1991/1992.

Coronary care: 1985, 19881993. No strokeregistration.

Local research interestsLocal studies linked to MONICA included physi-cal activity, diet and homocysteinaemia. Belfastjoined up with the three French MONICA centresin the ECTIM Study, a case-control study explor-ing the genetic basis of myocardial infarc-tion (leader: Franois Cambien), and the PRIMEcohort study of 10 600 Northern Irish and Frenchmen (leader: Pierre Ducimetire). The Belfast PIhas been active in the administration and co-ordination of research and secured EuropeanCommission funding for MONICA between 1996and 1999 through a BIOMED 2 grant, as well asfunding for the MORGAM study (see below).

Continuing activityThe MORGAM (MOnica Risk Genetics Archivingand Monograph) involves many MONICA andother centres and is coordinated from Belfast. Itincludes a general risk cohort, a genetic cohort,archiving the MONICA Database, and support

for work on this Monograph.

Key personnelPI: Alun Evans. Others: Malcolm Kerr, ZeldaMathewson, Mary McConville, Evelyn McCrum,Dermot OReilly,Susan Cashman.

Selected publications1. Gey KF, Stahelin HB, Puska P, Evans A. Rela-

tionship of plasma level of vitamin C to mor-tality from ischemic heart disease.Annals ofthe New York Academy of Sciences, 1987,498:110123. PMID:3497600.

2. Evans AE, Kerr MM,McCrum EE,McMaster D,McCartney LK, Mallaghan M, Patterson CC.

Coronary risk factor prevalence in a highincidence area: results from the BelfastMONICA Project. Ulster Medical Journal,1989,58:6068. PMID:2788947.

3. McClean R, McCrum E, Scally G, McMaster D,Patterson C, Evans A. Dietary patterns inthe Belfast MONICA Project. Proceedings ofthe Nutrition Society, 1990, 49:297305.PMID:2236094.

4. Evans AE, Patterson CC, Mathewson Z,McCrum EE, McIlmoyle EL. Incidence, delayand survival in the Belfast MONICA Projectcoronary event register. Revue dEpidmiolo-gie et de Sant Publique, 1990, 38:419427.PMID:2082447.

5. Parra HJ, Arveiler D, Evans AE, Cambou JP,

Amouyel P, Bingham A, McMaster D, ShafferP, Douste-Blazy P, Luc G et al. A case-controlstudy of lipoprotein particles in two popula-tions at contrasting risk for coronary heartdisease: the ECTIM Study. Arteriosclerosisand Thrombosis, 1992, 12:701707. PMID:1534257.

6. Cambien F, Poirier O, Lecerf L, Evans A,Cambou JP, Arveiler D,Luc G, Bard JM,Bara L,Ricard S, Tiret L, Amouyel P, Alhenc-Gelas F,Soubrier F. Deletion polymorphism in the

gene for angiotensin converting enzyme is apotent risk factor for myocardial infarction.Nature, 1992, 359:641644.PMID:1328889.

7. Evans AE, Zhang W, Moreel JF, Bard JM,RicardS, Poirier O, Tiret L, Fruchart JC, Cambien F.Polymorphisms of the apolipoprotein B andE genes and their relationship to plasmalipid variables in healthy Chinese men.Human Genetics, 1993, 92:191197. PMID:8370587.

8. Evans AE,Ruidavets JB,McCrum EE,CambourJP, McClean R, Douste-Blazy P, McMaster D,Bingham A, Patterson CC, Richard JL et al.Autres pays,autres coeurs? Dietary patterns,risk factors and ischaemic heart disease inBelfast and Toulouse. Quarterly Journal of

Medicine, 1995, 88:46977. PMID:7633873.9. Marques-Vidal P, Arveiler D, Evans A,

Amouyel P, Ferrires J, Ducimetire P. Dif-ferent alcohol drinking and blood pressurerelationships in France and Northern Ireland:The PRIME Study. Hypertension, 2001, 38:13611366.

Alun Evans

#80 United Kingdom-Belfast (UNK-BEL, UB)

Alun Evans

q very high coronary-event rates in both

sexes

q less extreme than Glasgow, its

neighbour across the sea, but similarq significant decline in event rates and

risk factors

q high scores for treatment of coronary

disease

Random-zero blood pressure measurement


15/19

MCC 37: Scottish MONICASingle Reporting Unit.

Administrative centreCardiovascular Epidemiology Unit, Dundee Uni-

versity, Ninewells Hospital,Dundee DD1 9SY,Scotland, United KingdomT +44 1382 641 764; F +44 1382 641 095Website: http://www.dundee.ac.uk/cardioepiunitMONICA Quality Control Centre for Event

Registration.Registration centre was in Glasgow Royal

Infirmary.

PopulationResidents aged 2564 of Glasgow city, north ofthe River Clyde. Built on former trade and heavyindustry, Glasgows inner city had high levels ofdeprivation, chronic disease and populationdecline. Chosen for its exceptional coronarydisease mortality in both sexes,survey response

rates were below average for Scotland, andMONICA. The total population in 1991 was392000.

Funding1. Chief Scientist Organization of the ScottishOffice Department of Health. 2. British HeartFoundation.

DatesCoronary-event registration and coronary caretogether: 198594 (*-96). Population surveys:1986,(1989*), 1992,1995. No stroke registration.(*) = omitted from WHO MONICA database.

Additional descriptionOriginally Scottish MONICA planned to comparetwo differing populations but the loss of Edin-burgh left Glasgow alone to represent Scotlandand mainland Britain. The first populationsurvey, with many items added to the MONICAprotocol as the Scottish Heart Health Study,visited 25 districts across Scotland recruiting12 000 men and women in 198487. Results ofthis study of risk factors and lifestyle led tonational policies on prevention. World-recorddisease rates in Glasgow,now in decline, causednational embarrassmentas well as perversepride. The Dundee Unit was home to theRapporteur and oversaw quality control work. Itwas also responsible for editing two MONICACongress supplements, and this Monograph.

Local research interestsCoronary disease and risk factors in women.Deprivation.Delivery of care. Sudden death andresuscitation. Comparison of classic with newrisk factors: fibrinogen, other haemostaticfactors, diet and vitamins. Left ventricular dys-function and heart failure. Helicobacter pylori,Chlamydia pneumoniae.

Continuing activityExtended ECTIM study, MORGAM (See Belfastpage). Registration ceased 1996, no MONICApopulation surveys after 1995. Cohort studies

continue.

Key personnelPI: Hugh Tunstall-Pedoe. Co-PI 1986: CarolineMorrison. Former CoPI (Population Surveys)

198490: Cairns Smith.Former CoPI (Event Reg-istration) 198486: Graham Watt. Biochemist1984: Roger Tavendale.

Selected publicationsComprehensive list and abstracts available at:http://www.dundee.ac.uk/ cardioepiunit1. Tunstall-Pedoe H, Smith WCS, Crombie IK,

Tavendale R. Coronary risk factor andlifestyle variation across Scotland: resultsfrom the Scottish Heart Health Study. Scot-tish Medical Journal, 1989, 34:55660.PMID:2631202.

2. Smith WCS, Lee AJ, Crombie IK, Tunstall-Pedoe H. Control of blood pressure in Scot-land: the rule of halves. British MedicalJournal, 1990, 300:9813. PMID:2344507.

3. Lean MEJ,Han TS,Morrison CE.Waist circum-ference as a measure for indicating the needfor weight management. British MedicalJournal, 1995, 311:158161.PMID:7613427.

4. Leslie WS, Fitzpatrick B, Morrison CE, WattGCM, Tunstall-Pedoe H. Out-of-hospitalcardiac arrest due to coronary heart disease:a comparison of survival before and after theintroduction of defibrillators in ambulances.Heart, 1996,75:195199.PMID:8673761.

5. Tunstall-Pedoe H, Morrison C, Woodward M,Fitzpatrick B, Watt G. Sex differences inmyocardial infarction and coronary deaths inthe Scottish MONICA population of Glasgow198591. Circulation, 1996, 93:19811992.PMID:8640972.

6. Morrison C, Woodward M, Leslie W,Tunstall-Pedoe H. Effect of socio-economic group onincidence of, management of, and survivalafter myocardial infarction and coronary

death:analysis of community coronary eventregister. British Medical Journal, 1997,314:541546. PMID:9055711.

7. Tunstall-Pedoe H,Woodward M,Tavendale R,ABrook R, McCluskey MK.Comparison of theprediction by 27 different factors of coronaryheart disease and death in men and womenof the Scottish Heart Health Study: cohortstudy. British Medical Journal, 1997, 315:722729. PMID:9314758.

8. McDonagh TA, Morrison CE, Tunstall-PedoeH, Ford I, McMurray JJV, Dargie HJ. Sympto-matic and asymptomatic left ventricular dys-function in an urban population. Lancet,1997, 350:829833,PMID: 9310600.

9. Woodward M, Lowe GD, Rumley A, Tunstall-Pedoe H. Fibrinogen as a risk factor forcoronary heart disease and mortality inmiddle-aged men and women.The ScottishHeart Health Study. European Heart Journal,1998, 19:5562. PMID:9503176.

10. Wrieden WL, Hannah MK, Bolton-Smith C,Tavendale R, Morrison C, Tunstall-Pedoe H.Plasma vitamin C and food choice in thethird Glasgow MONICA population survey.Journal of Epidemiology and Community

Health, 2000, 54:35560. PMID:10814656.

Hugh Tunstall-Pedoe,Caroline Morrison


#81 United Kingdom-Glasgow (UNK-GLA, UG)

Caroline Morrison

q only MONICA population from

mainland Britain

q

extreme coronary-event rates,particularly in women

q high scores for risk-factor change and

implementing coronary care

q modest change in end-points during

study period

q researching sex differences,

deprivation, fibrinogen, left ventricular

dysfunction, new risk factors

Hugh Tunstall-Pedoe

Measuring height

MONICA nurses


16/19


MCC 43:StanfordFour geographically separate Reporting Unitsmerged into one Reporting Unit Aggregate(RUA).

Administrative centreStanford Center for Research in DiseasePrevention,Stanford University School of Medicine,1000 Welch Road, Palo Alto, California, 94304-1825 USAT +1 650 723 6145; F +1 650 725 6906Website: http://prevention.stanford.edu/

PopulationResidents aged 2564 of four of the StanfordFive-City Project cities, a community cardiovas-cular disease prevention study. Salinas andModesto serve agricultural areas with relatedindustries, canning and wine production. Mon-

terey is a coastal city with a declining fishingindustry but tourism and military bases.San LuisObispo hosts a state university.All four were pre-dominantly middle-class but Salinas andModesto now include large economically-disad-vantaged and Mexican-American populations.The total population in 1991 was 380 000.

FundingNational Heart, Lung, and Blood Institute,National Institutes of Health, Public HealthService (HL 21906), 197898.

DatesCoronary-event registration: 19791992. Coro-

nary care: 19811982, 19851986, 19881992.Population surveys: 1979/80, 1985/86, 1989/90.No stroke registration for MONICA.

Additional descriptionThe Stanford Five-City Project began in 1978with two intervention cities (Monterey andSalinas) and three controls (Modesto, San LuisObispo, and Santa Maria). Population surveyswere not conducted in Santa Maria. Communityhealth education took place during 198086.Coronary and stroke events were registered toevaluate the interventions. When MONICA wasproposed in 1980 the Stanford MCC participatedusing data from the Five-City Project. The regis-tration procedures predated MONICA so chal-lenging manipulations were needed to providecompatible coronary-event datanot at-tempted for stroke.

Local research interestsCardiovascular disease epidemiology and pre-vention, cancer prevention, behavioural sci-ences, health communication, exercise,nutrition, lipid disorders, tobacco interventions

and control, successful ageing, womens health,social and cultural determinants of health,disease prevention in children and adolescents.

Continuing activityRegisters and population surveys have ended.

Key PersonnelPI: Stephen Fortmann. Other staff: Ann Varady,John Farquhar, William Haskell, Mary Hull,Marilyn Winkleby.

Selected publicationsComprehensive list available at:http://prevention.stanford.edu/

1. Gillum RF, Fortmann SP, Prineas RJ, Kottke TE.International diagnostic criteria for acutemyocardial infarction and acute stroke.American Heart Journal, 1984, 108:150158.PMID:6731265.

2. Farquhar JW, Fortmann SP, Maccoby N,Haskell WL, Williams PT, Flora JA, Taylor CB,Brown BW Jr, Solomon DS, Hulley SB. TheStanford Five-City Project: Design andmethods. American Journal of Epidemiology,1985, 122:323334.PMID:4014215.

3. Fortmann SP, Haskell WL,Williams PT, VaradyAN, Hulley SB, Farquhar JW. Communitysurveillance of cardiovascular diseases inthe Stanford Five-City Project: methods andinitial experience. American Journal of

Epidemiology, 1986, 123:656669. PMID:3953544.

4. Farquhar JW, Fortmann SP,Flora JA,Taylor CB,Haskell WL, Williams PT, Maccoby N, WoodPD. Effects of community-wide educationon cardiovascular disease risk factors. TheStanford Five-City Project. Journal of theAmerican Medical Association,1990,264:359365. PMID:2362332.

5. Fortmann SP, Winkleby MA, Flora JA, HaskellWL,Taylor CB.Effect of long-term communityhealth education on blood pressure andhypertension control. The Stanford Five-CityProject. American Journal of Epidemiology,1990, 132:629646.PMID:2403104.

6. Taylor CB, Fortmann SP, Flora J, Kayman S,Barrett DC, Jatulis D, Farquhar JW. Effect oflong-term community health education onbody mass index. The Stanford Five-City

Project. American Journal of Epidemiology,1991, 134:235249.PMID:1877583.

7. Fortmann SP, Taylor CB, Flora JA, Jatulis DE.Changes in adult cigarette smoking preva-lence after 5 years of community healtheducation: the Stanford Five-City Project.American Journal of Epidemiology, 1993,

137:8296. PMID:8434576.8. Fortmann SP, Taylor BC, Flora JA, WinklebyMA. Effect of community health educationon plasma cholesterol levels and diet: theStanford Five-City Project. American Journalof Epidemiology, 1993, 137:10391055.PMID:8317434.

9. Winkleby MA, Taylor CB, Jatulis D, FortmannSP. The long-term effects of a cardiovasculardisease prevention trial: the Stanford Five-City Project. American Journal of PublicHealth, 1996, 86:17731779.PMID:9003136.

10. Fortmann S, Varady A. Effects of a commu-nity-wide health education program on car-diovascular disease morbidity and mortality:the Stanford Five-City Project. American

Journal of Epidemiology, 2000, 152:316323.PMID:10968376.

Stephen Fortmann

#82 United States-Stanford (USA-STA, US)

Stephen Fortmann

q the only MONICA population from the

USA

q derived from monitoring of a

community prevention programme

q

rapidly falling coronary heart diseasemortality but rising revascularization

rates

q good risk-factor trends apart from

increasing obesity

q researching prevention and control of

chronic disease Ann Varady

Stanford


17/19

Additional descriptionNovi Sad is the only MONICA population inYugoslavia.The first MONICA survey determinedthe levels and distribution of major risk factors,contributing to preventive work on coronaryand cerebrovascular disease. In the period19841990 morbidity and mortality from coro-nary and cerebrovascular diseases fell by about20 percent. Since 1991, with war and economicsanctions,this beneficial trend has reversed andrates have increased continually.

Local research interestsRisk factors in children and young people.Primary prevention.Methodology of monitoringand evaluation; management.

Continuing activityEvent registration. Sample surveys, using theMONICA protocol. Preventive activities.

Key personnelPI: Milutin Planojevic. Former PI 19841986:Djordje Jakovljevic. Other staff: A Svircevic, DStojsic,T Djapic,M Zikic,P Terzic,Z Solak,V Grujic.

Selected publications1. Djapic T, Karanov Z. Influence of reduced

nutrition on height of systolic and diastolicblood pressure. Medicinski Pregled, 1980,33:369374. PMID:na.

2. Zikic M. Report of the basic characteristicsof the CVD prophylactic program on the ter-ritory of Novi Sad community. Abstracts ofthe 14th World Congress of the Neurology,New Delhi. In: Neurology India, 1989,

37(suppl);102. PMID:na.3. Zik ic M, Knezevic S, Jovanovic M,

Slankamenac P. Stroke epidemiology in NoviSad. Neurologia Croatica (Yugoslavia), 1991;40:171179. PMID:1932441.

4. Jakovljevic D, Grujic V, Atanackovic D. Hyper-tension text book for general practitioners,Federal Institute of Public Health, 1995,Belgrade. PMID:na.

5. Planojevic M. The role of the general pra-ctitioner in the prevention and control ofmodern diseases. Medicinski Pregled, 1995,48:231235. PMID:8524192

6. Radovanovic N, Jakovljevic D. Quality of lifeafter open heart surgery, a research study,Institute of Cardiovascular Diseases, Novi

Sad,1997. PMID:na.7. Dodic B, Planojevic M, Jakovljevic D,Dodic S.

[Distribution of the major cardiovascular riskfactors in the adult population of Novi Sad.]Medicinski Pregled, 1997, 50:5355. (Serbo-Croat). PMID 9132554.

8. Stojsic D, Benc D,Srdic S, Petrovic M,Tomic N,Stojsic-Milosavljevic A, Panic G, Sakac D.

Treatment of acute coronary syndrome. Insti-tute of Cardiovascular Diseases, SremskaKamenica. In press, Balneoclimatologia.PMID:na.

Milutin Planojevic,Djordje Jakovljevic


#83 Yugoslavia-Novi Sad (YUG-NOS, YU)

Milutin Planojevic

q from the banks of the Danube in

Yugoslavia

q greatest increase and highest risk-

factor scores in MONICA

q declining event rates reversed into

increase

q maintained MONICA collaboration

despite war and economic sanctions

Djordje Jakovljevic

Novi Sad

MCC 49: Novi SadSingle Reporting Unit.

Administrative centreInstitute of cardiovascular diseaseInstitutski put 421204 Sremska Kamenica,

Novi Sad, Serbia and MontenegroT +381 21 612 682; F +381 21 622 059E-mail: [email protected]

PopulationCitizens aged 2564 of the city of Novi Sad, amultiethnic and multicultural society of some 20nationalities. Novi Sad, on the river Danube, isthe administrative, economic, cultural and edu-cational centre of Vojvodina province.There areseveral hospitals, a medical centre and a univer-sity medical school. Mortality from cardiovascu-lar and cerebrovascular disease is the highest inthe country. Response to population surveyswas very good.The total population in 1991 was273000.

FundingRegular health insurance fund.

DatesCoronary and stroke-event registration:19841995. Coronary care: 19871995. Popula-tion surveys: 1984, 1988/1989, 1994/95.


18/19


Some MONICA Collaborating Centres did notcontribute to collaborative testing of hypothe-ses on trends because data received in the

MONICA Data Centre were too scanty, of inade-quate quality, or not received in time to do this.Much time and effort were spent over manyyears trying to help the MCCs that were ex-periencing difficulties. Eventually some wereencouraged to withdraw, some failed to meetdeadlines for data, some discovered major prob-lems with their data which could not beresolved, some failed to obtain continuousfunding for the local activities and others simplylost contact, failing to reply to repeated com-munications.Brief descriptions follow, includingwhat data were registered in the MONICA DataCentre in Helsinki and used in cross-sectionalanalyses for data books and publications.Note that comments below on what data were

used apply to data that went through the fullquality control checks in Helsinki and led to col-laborative publications in scientific journals. Forsome MCCs an accelerated procedure was usedfor the 1989 World Health Statistics Annual,which also included national mortality statistics.Partial data from some of the former MONICApopulations, which were not used elsewhere,were used in that publication. (1). This appliesparticularly to routine mortality and de-mographic data which were collected fromthe populations before the quality of specificMONICA data was known.

Belgium-Luxembourg (BEL-LUX)MCC 14: MONICA-BelluxLuxembourg is the south-east province ofBelgium. Rural and forested its low density pop-

ulation is characterized by traditional lifestyles,low socioeconomic status, high mortality andlow migration.PI: M Jeanjean. Inter-University Associationfor Prevention of Cardiovascular Disease, UCLBrussels.Routine mortality: 19841987. Demographicdata: 19811994. Coronary-event data:19851991. Coronary care data: none used.Population survey: 19831985. No strokeregistration.Problems: after several years of collaboration,data stopped coming to the Data Centre.

Germany-East Germany (GER-EGE)MCC 23: MONICA East Germany, formerlyknown as DDR-MONICAThis MCC began with 39 Reporting Units, butmanaged to survive with only 3, one of whichrecorded coronary care. The MCC therefore sur-vived and contributed to MONICA. Most of itsinitial population Reporting Units either did notcontribute or did so only to early cross-sectionalpapers. See #65 Germany-East Germany.)

Germany-Rhein-Neckar Region(GER-RHN)

MCC 25: HeidelbergThe region of Baden-Wrtenberg is a mixedurban and rural region.It includes the universitytown of Heidelberg. There is medium industry,the population enjoying high socioeconomicstatus and average mortality and risk-factorlevels.PI: E Nssel. Former Co-PI: E str-Lamm,Dept.ofClinical and Social Medicine, University MedicalClinic, Heidelberg.Routine mortality: 19831989. Demographicdata: 19831989. Coronary-event data and coro-nary care data: 19841988. Population survey:19831987. Stroke-event data: 19841987.Problems: data stopped coming to the DataCentre following the retirement of Dr str-

Lamm.

Hungary-Budapest (HUN-BUD),Hungary-Pecs (HUN-PEC)MCC 27: HUN-MONICABudapest: three industrial districts of southBudapest, inhabitants living mainly in blocks offlats with a population of low and middlesocioeconomic status.Pecs: third largest town in Hungarys south-west. The population enjoys above averagesocioeconomic status. An industrial area domi-nated by mining.The region was involved in theHealthy Cities and WHO CINDI Projects.PI: J Duba. National Institute of Cardiology,Budapest.

Routine mortality: 19821991. Demographicdata: 19821992. Coronary-event registration:19821989 (Budapest), 19841989 (Pecs). Coro-nary care data not used. Population surveys:19821984, 19871989 (Budapest), 19821983,19871988 (Pecs).Stroke-event data: 19831989(Budapest), 19841989 (Pecs).Problems: serious problems were discoveredwith the quality of initial survey data, and whengaps were discovered in the coverage of coro-nary and stroke-event registration the combina-tion of problems proved irremediable.

Israel-Tel Aviv (ISR-TEL)

MCC 30: Israel-MONICAHolom and Bat Jam suburbs of Tel Aviv. Thepopulation is mainly middle and lower middle-class with blue-collar workers.PI: D Brunner. Donolo Institute of PhysiologicalHygiene, University of Tel Aviv.Population survey: 19851986. No routine mor-tality, demographic, coronary event, coronarycare or stroke-event data used in collaborativeanalyses.Problems: non-receipt of data according toMONICA protocol requirements.

Italy-Latina (ITA-LAT)MCC 31: Area LatinaProvince of Latina and neighbouring healthunits in the region of Lazio, south of Rome. Theregion was malarious until the 1920s. Eighty

#84 Former MONICA Populations

TEL

JPN

LUX

RHN

BUD

BUC

LAT

MLT

EDI

PEC

BEL

q never started

q stopped early from change in funding

or control

q missed deadlines for data transfer

q or transferred data that could not be

used


19/19

percent of the region is rural. Low incidencearea.PI: G Righetti, Cardiology Dept, SM Goretti Hos-pital, Latina.Population survey: 19821985. No routinemortality, demographic, coronary-event data,coronary care or stroke-event data used incollaborative analyses.Problems:early loss of funding led to withdrawal

of this population.

Japan (JPN-JPN)MCC 58: Japan MONICATwenty Reporting Units (1985) scattered overJapan.PI: S Hatano. Former PI: I Shigematsu. JapaneseAssociation for Cerebro-Cardiovascular DiseaseControl.No Japanese data used in collaborative analyses.Problems: the MCCs attempt to adapt a largenumber of different local monitoring studies tothe MONICA Project was not successful becauseof major methodological and structural differ-ences in the study protocols. The very largenumber of Reporting Units gave the PrincipalInvestigators similar problems to those in EastGermany. Loss of this Asian population fromMONICA was much regretted.

Malta (MLT-MLT)MCC 52: MaltaThe island of Malta, not including its neighbourGozo.PI: Government Chief Medical Officer. Former Co-PIs: J Cacciottolo, J Mamo.

Population survey: 1984. No routine mortality,demographic, coronary-event, coronary care orstroke-event data used in collaborative analyses.Problems: data stopped coming to the DataCentre following the retirement of DrCacciottolo.

Romania-Bucharest (ROM-BUC)

MCC 53: BucharestPart of Bucharest and possibly a neighbouringrural area.PIs:C Carp,I Orha.Medical Institute,Fundeni Hos-pital, Bucharest.Population survey: 19861987. No routine mor-tality, demographic, coronary-event, coronarycare or stroke-event data used in collaborativeanalyses.Problem: non-receipt of data according toMONICA protocol requirements, poor definitionof study population. Catastrophic earthquake.

United Kingdom-Edinburgh

(UNK-EDI)MCC 38: Scottish MONICA EdinburghEdinburgh city, Scotland.PI: H Tunstall-Pedoe. Co-PI: W Symmers.Population survey: 1986. No data used in col-laborative analyses.Problems: pilot studies showed cold pursuit ofcoronary cases failed to capture them all,but hotpursuit would need to be prohibitively intensiveand expensive because of the rapid movementof cases through the hospitals.Survey data weresent to Helsinki from the 1986 survey but were

purged when the MCC was withdrawn. Unlikethe survey data from MCCs whose other prob-lems emerged later, Edinburghs initial surveydata were not therefore used in cross-sectionalanalyses.

Yugoslavia-Belgrade ( YUG-BEL)City of Belgrade.

PI: D Kozarevic.Institute of Chronic Diseases andGeron

Documents

MArtignacco_e110_128