Twenty Years Trend in Coronary Heart Disease Rates in the Monica-Brianza Population

Aims. To assess the 20-year trends in coronary heart disease in a northern Italian population. Methods. The MONICA and CAMUNI MI registries collected and validated data on acute coronary events occurred to residents in Brianza during three time periods: 1985-94 (MONICA); 1997-98 and 2003-04 (CAMUNI). Suspected hospitalized coronary events were identified from selected hospital discharge codes; subsequent events within 28 days were considered as one. Out-of-hospital deaths were identified from selected ICD-IX codes on death certificates. Available clinical information was collected and reviewed by trained staff to assign MONICA diagnostic categories. We report on directly age-standardized mortality and attack rates (per 100.000 py) for men and women aged 35-64 (European standard population as reference). The coronary events were defined as “hard” (MONICA definite non fatal cases) and “any” (including also possible MONICA cases) . Average annual change (AAC) in event rates were calculated using sex specific log-linear models, accounting for Poisson over-dispersion. Results. Age-standardized mortality and attack rates are reported in Figure 1. Validated mortality decreased among men (AAC: -5.3%; 95%CI -6.3;-4.3) and women (AAC: -5.5%; 95%CI -7.8;-3.3) during the entire time period. The same trend was observed for attack rate (hard CHD): AAC=-2.4% among men (95%CI -2.7;-2.1) and AAC=-2.2% (95%CI -3.5;-0.8) among women. Considering the “any” CHD events, the rate was stable in men up to 1998, and it decreased thereafter. Conclusions. We observed in a low incidence population a consistent decline in CHD event rates for the entire time period. Both reductions in attack rate and case-fatality contributed to a significant reduction of mortality rate among men and women.