Is there coherent pan-European epidemiology? What do the numbers mean?

Coronary heart disease (CHD) is the leading manifestation of cardiovascular diseases and represents one of the main causes of death throughout Europe. However, there are important differences in the relative frequency of CHD throughout Europe. Results show a clear East-West gradient, with higher mortality rates seen in Eastern European countries. The World Health Organization MONICA project was designed to evaluate trends and determinants in cardiovascular mortality and morbidity, and to assess their relationship with known risk factors and health care, using a standardized protocol. Data have confirmed that there are geographical differences in CHD attack rates. A large variation in the prevalence of modifiable risk factors has also been revealed, which may explain the discrepancies observed in CHD mortality. These risk factors include elevated:serum total cholesterol, arterial hypertension, cigarette smoking and obesity. The EUROASPIRE study also demonstrated a high prevalence of,modifiable risk factors in coronary patients 6 months after a major coronary event. In addition, important geographical variations in the clinical practice of secondary prevention of CHD were observed in this study. Overall, these multinational studies highlight a considerable potential for cardiologists, physicians and public health professionals to reduce further:cardiovascular morbidity and mortality in Europe.