The association between BMI, vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema in children and adolescents: ISAAC Phase Three.

BACKGROUND: Several studies have observed an association between obesity and asthma, but whether or not there is an association with rhinoconjunctivitis or eczema is unclear. AIMS: To examine the relationship between body mass index categories (underweight, overweight and obesity), vigorous physical activity and television viewing and the risk of symptoms of asthma, rhinoconjunctivitis and eczema. METHODS: As part of International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, parents or guardians of children aged 6-7 years completed written questionnaires about symptoms of asthma, rhinoconjunctivitis and eczema, and several potential risk factors, such as vigorous physical activity and television viewing, and other information such as the child's height and weight. Adolescents aged 13-14 years self-completed the questionnaires on these symptoms and potential risk factors and reported their own height and weight. For 28% of children and 24% of adolescents, the height and weight was objectively measured. RESULTS: A total of 76 164 children aged 6-7 years (from 29 centres and 17 countries) and 201 370 adolescents aged 13-14 years (from 73 centres and 35 countries) provided data meeting the inclusion criteria. There were associations between overweight and obesity, but not underweight, and symptoms of asthma and eczema but not rhinoconjunctivitis. Vigorous physical activity was positively associated with symptoms of asthma, rhinoconjunctivitis and eczema in adolescents, but not children. Viewing television for five or more hours/day was associated with an increased risk of symptoms of asthma, rhinoconjunctivitis and eczema in adolescents and symptoms of asthma in children. CONCLUSIONS AND CLINICAL RELEVANCE: This study has confirmed the association between overweight and obesity and symptoms of asthma. It has extended these observations to include significant associations with symptoms of eczema, but not rhinoconjunctivitis. There are complex relationships between obesity, vigorous physical activity and sedentary behaviour and the symptoms of asthma, rhinoconjunctivitis and eczema in children.

The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis.

This ISAAC Phase Three synthesis provides summarised information on the main findings of the study, regional tables and figures related to the prevalence and severity of current symptoms of asthma, rhinoconjunctivitis and eczema in the main regions of the world. The large number of surveyed children (≈1,200,000), the large number of centres (233) and countries (98) that participated in ISAAC Phase Three makes this study the most comprehensive survey of these diseases ever undertaken. Globally, the prevalence for current asthma, rhinoconjunctivitis and eczema in the 13-14-year age group was 14.1%, 14.6% and 7.3%, respectively. In the 6-7-year age group the prevalence for current asthma, rhinoconjunctivitis and eczema was 11.7%, 8.5% and 7.9%, respectively. The study shows a wide variability in the prevalence and severity of asthma, rhinoconjunctivitis and eczema which occurs not just between regions and countries but between centres in the same country and centres in the same city. This study definitively establishes that the prevalence of those diseases can be very high in non-affluent centres with low socioeconomic conditions. The large variability also suggests a crucial role of local environment characteristics to determine the differences in prevalence between one place and another. Thus, ISAAC Phase Three has provided a large body of epidemiological information on asthma, rhinoconjunctivitis and eczema in childhood from contrasting environments which is expected to yield new clues about the aetiology of those conditions and reasons for their marked global variability.

Implications of prevalent and incident diabetes mellitus on left ventricular geometry and function in the ageing heart: the MONICA/KORA Augsburg cohort study.

BACKGROUND AND AIM: It is unclear to what extent diabetes modulates the ageing-related adaptations of cardiac geometry and function. METHODS AND RESULTS: We examined 1005 adults, aged 25-74 years, from a population-based survey at baseline in 1994/5 and at follow-up in 2004/5. We compared persistently non-diabetic individuals (ND; no diabetes at baseline and at follow-up, n=833) with incident (ID; non-diabetic at baseline and diabetic at follow-up, n=36) and with prevalent diabetics (PD; diabetes at baseline and follow-up examination, n=21). Left ventricular (LV) geometry and function were evaluated by echocardiography. Statistical analyses were performed with multivariate linear regression models. Over ten years the PD group displayed a significantly stronger relative increase of LV mass (+9.34% vs. +23.7%) that was mediated by a more pronounced increase of LV end-diastolic diameter (+0% vs. +6.95%) compared to the ND group. In parallel, LA diameter increased (+4.50% vs. +12.7%), whereas ejection fraction decreased (+3.02% vs. -4.92%) more significantly in the PD group. Moreover, at the follow-up examination the PD and ID groups showed a significantly worse diastolic function, indicated by a higher E/EM ratio compared with the ND group (11.6 and 11.8 vs. 9.79, respectively). CONCLUSIONS: Long-standing diabetes was associated with an acceleration of age-related changes of left ventricular geometry accumulating in an eccentric remodelling of the left ventricle. Likewise, echocardiographic measures of systolic and diastolic ventricular function deteriorated more rapidly in individuals with diabetes.

Alcohol consumption as a risk factor for high blood pressure. Munich Blood Pressure Study.

The Munich Blood Pressure Study (MBS), a 1980-81 cross-sectional study (with follow-up) of a random sample of 3198 Munich citizens aged 30-69 years (response rate 69%), revealed hypertensive blood pressure (BP) values in 17.7% of men and 10.7% of women (WHO criteria). One of the main goals of the MBS was to search for social, behavioral, and environmental risk factors for hypertension. The relationship between BP and five possible risk factors--alcohol consumption (g/day), cigarette smoking, oral contraceptive use, years of education, obesity (BMI)--has been examined. The major emphasis of this report is the relationship of alcohol consumption to BP. Multiple linear and logistic regression analyses were run controlling for both age and sex. All second- and third-order interactions between the independent variables were tested during a backward-stepping procedure. Alcohol consumption appeared as a significant main effect in many of the analyses. The coefficient of the alcohol variable ranged from 0.02 to 0.06 for men and women in the separate linear regression analyses for systolic and diastolic BP. Thus, for example, according to the model, the daily consumption of 1 liter of beer (40 g alcohol) may cause an increase in diastolic BP in women of 2.4 mm Hg.

The angiotensinogen T235 variant and the use of antihypertensive drugs in a population-based cohort.

Variants of the angiotensinogen gene may increase the risk of developing arterial hypertension, but their effect on the use of antihypertensive medication in the general population remains unclear. Thus, we determined T174M and M235T allele status and angiotensinogen plasma levels in a cross-sectional sample of 634 middle-aged subjects (48.4% men) from the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Augsburg cohort study. We found no association between T174M allele status and angiotensinogen levels, blood pressure, or use of antihypertensive drugs. In contrast, multivariate analysis revealed that individuals who carried at least one copy of the T235 allele (n = 418) had higher systolic and diastolic pressures (P = .007) and .008, respectively) and were more likely to use an antihypertensive drug (1.6-fold risk, P = .04) than homozygotes for the M235 allele (n = 216). The likelihood of taking two or more antihypertensive medications was 2.1-fold higher in carriers of the T235 allele (P = .02). Overall, 22.5% of all antihypertensive drugs taken appeared to be attributable to the excess risk associated with this allele. These associations were replicated in two previous surveys carried out on the same individuals over 10 years. Furthermore, the T235 allele was related to higher angiotensinogen plasma levels [15.5 +/- 0.31 versus 16.5 +/- 0.15 (nmol/L)/L in homozygotes for the M235 and T235 alleles, respectively; P < .01], which were also related to systolic pressure (P = .03) and more intensive antihypertensive medication (P = .03). We conclude that the angiotensinogen T235 allele accounts for a substantial proportion of antihypertensive drug use in this middle-aged, population-based group of white subjects.

Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and Morbidity in Augsburg Elderly.

OBJECTIVE: To evaluate prevalence, sociodemographic characteristics, and risk factors of restless legs syndrome (RLS) in a population-based survey of the elderly, using standard diagnostic criteria. BACKGROUND: Population-based studies of RLS are rare and have not yet used standard definition criteria. METHODS: The Memory and Morbidity in Augsburg Elderly (MEMO) Study is a follow-up project of the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Survey-Augsburg, Germany, 1989-1990, evaluating neurologic diseases and their risk factors in a German population 65 to 83 years of age. Two RLS-trained physicians assessed the prevalence of RLS based on the four minimal standard criteria (International Restless Legs Syndrome Study Group, 1995) using standardized questions in face-to-face interviews. They also obtained information on medical history, medications, depression (Center of Epidemiologic Studies Depression Scale), and quality of life (Short Form 36) and performed a standardized neurologic examination for each participant. RESULTS: The study population included 369 participants (173 women and 196 men). The overall prevalence of RLS was 9.8% (n = 36) and higher in women (13.9% versus 6.1%; p = 0.02). In women, the prevalence did not change with age, whereas men showed a nonsignificant inverse trend with increasing age. RLS-positive individuals took more benzodiazepines and estrogen compared with non-RLS cases, but the differences were not statistically significant. Participants with RLS had higher incidence of depression (p = 0.012) and lower self-reported mental health scores (p = 0.029) than did non-RLS cases. CONCLUSIONS: RLS is a frequent syndrome in the elderly with considerable impact on self-perceived mental health, affecting women about twice as often as men.

Lack of an association between serum vitamin E and myocardial infarction in a population with high vitamin E levels.

The antioxidant effects of vitamin E may protect low density lipoproteins from peroxidation and thus inhibit the development of arteriosclerosis. Inverse associations between vitamin E levels and coronary heart disease have been reported from cross-sectional and ecologic studies. In the population-based MONICA Augsburg cohort (2023 men, 1999 women, age 25-64 years at baseline in 1984, 93% of whom were reexamined in 1987/88) we investigated the relationship between serum vitamin E concentrations and the risk of subsequent myocardial infarction (MI). Between 1984 and 1991, 46 cases of fatal and non-fatal myocardial infarction from this cohort were recruited for a nested case-control study. Four controls were sampled from the cohort for each case of MI with matching for age, sex, and total cholesterol. There were no marked differences between cases and their matched controls in the means of vitamin E concentrations (33.9 mumol/l vs. 32.8 mumol/l, P = 0.37) or in the mean vitamin E/total cholesterol ratios (4.89 mumol/mmol vs. 4.82 mumol/mmol, P = 0.75). The covariate adjusted relative risk (RR) for fatal plus non-fatal MI in the lowest tertile of vitamin E relative to the upper two tertiles was 0.72 (90% confidence interval: 0.33-1.57). Likewise, for the lowest tertile of the ratio (vitamin E/total cholesterol) the RR was 0.81 (0.42-1.56). The association was not modified by history of previous coronary heart disease, fatality of MI, temporal distance of MI onset from vitamin E determinations, or season.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol and blood pressure and its interaction with smoking and other behavioural variables: results from the MONICA Augsburg Survey 1984-1985.

Data from the Augsburg Survey 1984-1985 of the WHO-project Monitoring Trends and Determinants in Cardiovascular Disease (MONICA), a cross-sectional study on a two-stage cluster sample (n = 5312) of the 25-64-year-old population of the Augsburg study area, were analyzed with regard to alcohol consumption and blood pressure. Putative confounders such as age, body mass index, smoking, sporting activity and educational attainment were controlled for by multiple regression analyses. The main effect models showed that men aged 25-64 years consuming greater than or equal to 80 g alcohol per day had, on average, 3-11 mmHg higher systolic blood pressure (SBP) values and 2-6 mmHg higher diastolic blood pressure (DBP) values compared with non-drinkers. Women consuming greater than or equal to 40 g alcohol per day showed consistently higher SBP (2-6 mmHg) and DBP (1-5 mmHg) values compared with non-drinkers. In the group aged 55-64 years, no clear relationship was seen for SBP or DBP in men or women. Multiple regression models, allowing for interactions between alcohol consumption and the four behavioural variables: smoking, sporting activity; coffee consumption; and type A/B behaviour, showed a consistent interaction between alcohol consumption and smoking in men and women. Smoking modified the effect of alcohol on SBP and DBP in men by 2-8 mmHg and in women by 1-14 mmHg. These findings confirm those obtained for women in previous studies in Munich and Lübeck. Interactions between alcohol and sporting activity, coffee consumption and type A/B behaviour are less consistent.

Diagnosis and management of hypertension by physicians in the Federal Republic of Germany.

Diagnosis and management of hypertension by physicians in two large cities in the northwest of Germany were studied in 1988. Three hundred and fifteen out-of-hospital physicians (71%) responded to a mailed questionnaire. Sixty-eight per cent reported measuring blood pressure at almost each patient visit and 36% involved allied health professionals in the measurement process. Only 63% used disappearance of sound for the diastolic reading (phase V). A comparison with US data from 1987 showed that German physicians started drug therapy at higher levels of diastolic blood pressure than their American colleagues. Only 43% of the German physicians initiated antihypertensive medication at diastolic blood pressure values below 100 mmHg; this compares with 92% for US physicians. In Germany, beta-blockers were clearly preferred as step-one therapy for young patients, while diuretics were prescribed for the majority of the older patients. Forty per cent reported reducing or stopping antihypertensive medication when the blood pressure was controlled.

Weight change and change of total cholesterol and high-density-lipoprotein cholesterol. Results of the MONICA Augsburg cohort study.

Data from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg cohort were used to study the effect of weight change on changes in serum levels of total and high-density-lipoprotein cholesterol. Weight gain was associated with rising levels of total cholesterol and falling levels of high-density-lipoprotein cholesterol in both sexes, more so in men than in women. Moreover, these relationships weakened with advancing age in women, but not in men. The results support the view that weight loss may more favorably affect lipid levels in men than in women, particularly at older ages.

Five-year changes in population blood pressure and hypertension prevalence. Results from the MONICA Augsburg surveys 1984/85 and 1989/90.

Two cardiovascular risk factor surveys were carried out in 1984/85 and 1989/90 in the Augsburg study region of the international World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) project. Independent random samples of the 25- to 64-year-old population were examined at each survey. Five-year changes in blood pressure (BP) and hypertension parameters were monitored in a population not targeted by any formal intervention program. Response rates in both surveys ranged close to 80%. Evaluation of selected quality indicators confirmed comparability of the two surveys in terms of BP measurement quality. Small but consistent decreases in mean systolic and diastolic BP were observed, particularly for women 35 years and older, whereas BP changes in men were less pronounced and inconsistent. Likewise, downward shifts of the 10th, 50th, and 90th percentiles of systolic and diastolic BP occurred in women and their slopes of BP rise with age decreased while such changes were less clear in men. The age-standardized prevalence of men and women with hypertensive BP (HBP; > or = 160/95 mm Hg) decreased slightly. This contrasted with rises in the prevalence of actual hypertension (those with HBP plus those taking antihypertensive drugs) for 45- to 64-year-old men, which originated from changes in hypertension management involving a more frequent drug treatment of borderline-hypertensive men (140 to 159/90 to 94 mm Hg) in 1989/90. There were notable overall increases in the awareness, treatment, and control of men and women with hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Self-reported wheezing and allergic rhinitis in children and traffic density on street of residence.

A survey of 2050 seventh- and eighth-grade schoolchildren was conducted in Bochum, Germany, in 1991. The prevalence of wheezing and allergic rhinitis was assessed by self-completed written questionnaires and video questionnaires. To estimate the traffic density on the street of residence, children were asked about the frequency of heavy truck traffic on weekdays and to describe the street either as a main road or as a side street. There was a positive correlation between the prevalence of wheezing as well as allergic rhinitis and the indicators of traffic density, controlling for age, sex, nationality, passive smoking, active smoking, parental history of asthma, and so on. The adjusted prevalence odds ratio (ORs) and 95% confidence intervals (CIs) contrasting the "frequent" and "constant" categories for truck traffic with the "never" category were as follows: for wheezing (written questionnaire), OR = 1.53 (CI: 1.06 to 2.20) and OR = 1.67 (CI: 1.05 to 2.66); for wheezing (video questionnaire), OR = 1.58 (CI: 1.13 to 2.20) and OR = 1.94 (CI: 1.26 to 2.99); and for allergic rhinitis, OR = 1.67 (CI: 1.17 to 2.38) and OR = 1.54 (CI: 0.97 to 2.44). In conclusion, a possible role of factors associated with automobile exhausts causing or exacerbating asthma symptoms and allergic rhinitis in children is supported.

Development of the multiple metabolic syndrome in the ARIC cohort: joint contribution of insulin, BMI, and WHR. Atherosclerosis risk in communities.

PURPOSE: The natural history of the multiple metabolic syndrome (MMS) and its predictors has rarely been addressed in population samples. This study evaluated the predictive role of fasting serum insulin, body mass index (BMI), and waist-to-hip ratio (WHR) on the development of incident MMS components (diabetes, hypertension, and dyslipidemias) over the course of three years. METHODS: The study population comprised the cohort of middle-aged African American and European American men and women of the Atherosclerosis Risk in Communities Study (1987-1992). RESULTS: Among 6113 individuals free of MMS components at baseline, high insulin (> 14 microU/ ml) was independently predictive of the development of one or more MMS components (OR:1.5, 95% CI:1.2-1.8), as was a BMI > or = 30 (OR:1.7, 95% CI:1.4-2.0), and a high WHR (> 0.98) (OR:1.5, 95% CI:1.3-1.8) adjusting statistically for age, gender, and ethnicity/center. These associations were markedly stronger for combinations of MMS components (two or more) than for isolated components. CONCLUSIONS: The findings confirm earlier reports on the predictive role of insulin, BMI, and WHR, and suggest that these antecedent factors may be integral to the development of combinations of disorders, i.e., the particular clustering identified as the MMS.

Alcohol, blood pressure and hypertension.

In the last 30 years a large number of cross-sectional studies, a smaller number of prospective cohort studies and several intervention studies have addressed the alcohol-blood pressure relationship. Although a number of questions--such as the validity of measurement of alcohol intake, shape of the alcohol-blood pressure relationship, threshold dose for hypertension, and plausible pathophysiological mechanisms--have not yet been answered satisfactorily, it is clear that a causal association exists between chronic intake of > or = 30-60 g alcohol per day and blood pressure elevation in men and women. To call the alcohol-blood pressure relationship causal is justified because chance and, to a large degree, bias and confounding, have been ruled out as plausible explanations in most observational studies. More importantly, the intervention studies support the observational studies and show a remarkable consistency in demonstrating a potentially valuable decrease in blood pressure when heavy drinkers abstain or restrict their alcohol intake. From the different studies a rule of thumb can be derived: above 30 g of alcohol intake per day an increment of 10 g of alcohol per day increases on average systolic blood pressure by 1-2 mmHg and diastolic blood pressure by 1 mmHg.

Case finding, data quality aspects and comparability of myocardial infarction registers: results of a south German register study.

The population-based Augsburg Coronary Event Register (330,000 residents, age 25-74 years) has registered a total of 1012 cases of acute myocardial infarction (AMI) in 1985 and 1021 AMI in 1986 and categorized them on the basis of the current WHO diagnostic algorithm for AMI. The register is designed for longitudinal comparisons of annual AMI risk (incidence, attack rate, death rate), and the risk to the AMI patients themselves (28-day case fatality). The methodology and specific issues encountered during registration and data evaluation are described. With an estimated 95% completeness of case finding, the quality control data review which the register conducts annually shows a consistency of specific data structures which indicate stable case finding and validation procedures. However, local conditions which affect case finding and data completeness per case are responsible for the creation of subsets of AMI which are in turn distinguished by differences in diagnostic category structures. With regard to the study objectives, the differences among subsets appear to have the least effect on rate calculations if DEFINITE and POSSIBLE AMI are combined. The implications of methodological variations and subset differences within and across registers on annual rate calculations and result comparisons are discussed.

The association of antihypertensive treatment patterns and adverse lipid effects in population-based studies.

We investigated the relationship between antihypertensive drug treatment of hypertensives and their mean serum lipid concentrations in population based studies in Germany. Data from three surveys (Luebeck Blood Pressure Study (LBS) of 1984, MONICA Augsburg Survey I of 1984/85, MONICA Augsburg Survey II of 1989/90), obtained on random samples of the population aged 25-64 years, were used for cross-sectional analyses. Moreover, prospective analyses were carried out on participants of the MONICA Augsburg cohort study of 1987/88 (3-year-follow-up of the MONICA Survey I). Blood pressure, non-fasting serum total cholesterol and HDL-cholesterol, and body height and weight were measured under strictly standardized conditions. Interview data were available on medical history including medication use, and on smoking and alcohol consumption. In cross-sectional and prospective analyses treated male and female hypertensives in each population had significantly lower crude mean HDL-C concentrations than untreated hypertensives, borderliners, or normotensives. Differences in mean HDL-C between untreated and treated hypertensives were attenuated but still significant after control of confounders and ranged from 1.8 to 6.1 mg/dl (i.e. in relative terms, -3.4 to -12.9%) in men and from 3.6 to 9.4 mg/dl (-5.7 to -14.9%) in women. By contrast, crude and multivariate associations of antihypertensive treatment with non-HDL-C (total minus HDL-C) levels were inconsistent and not significant. The inverse association of drug therapy with HDL-C was confirmed by prospective analyses in the MONICA cohort study supporting a causal relationship. Treatment patterns in a community (prevalence of prescribed drug classes) correlated with the magnitude and significance of HDL-C effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Population trends in antihypertensive drug use: results from the MONICA Augsburg Project 1984 to 1995.

Trends in antihypertensive drug use were assessed among 25- to 64-year-old participants of three independent surveys of the MONICA Augsburg region in 1984/85, 1989/90, and in 1994/95. Despite constant prevalences of hypertension, the percentage of hypertensives taking medication increased over the study period. The latter was mainly due to significant rises in antihypertensive monotherapy. By contrast, the use of combination treatments with two or more agents remained constant; however, although combinations composed of only two drugs were taken more often in 1995, those with three or more agents and fixed-dose preparations decreased substantially. Beta-blockers were most frequently, and with a rising tendency, taken as antihypertensive monotherapy. Newer drug classes like calcium channel blockers and ACE-inhibitors were introduced as monotherapy more hesitantly. Diuretics persisted as the basis of antihypertensive combination therapy. The use of combination therapies containing obsolete drugs, like reserpine, declined significantly with corresponding increases in drug combinations of, in particular, calcium channel blockers or ACE-inhibitors. We conclude that monotherapies account for most of the rising antihypertensive treatment rates and probably reflect intensified therapy of borderline hypertensives. The trends in antihypertensive drug classes and treatment regimens reflect a less rapid adoption of novel therapeutic concepts but a fairly close adherence to national and international guidelines.

Coronary heart disease mortality, morbidity, and case fatality in five east and west German cities 1985-1989. Acute Myocardial Infarction Register Teams of Augsburg, Bremen, Chemnitz, Erfurt, and Zwickau.

Cardiovascular mortality (CVD; International Classification of Diseases [ICD] 390-458) is higher in East than in West Germany, but the differences in official coronary heart disease mortality (CHD; ICD 410-414) are not so pronounced. The aim of this study was to validate the official mortality statistics based on the five German AMI registers and to analyze whether these mortality differences are due to differences in the attack rates of acute myocardial infarction (AMI) or to differences in the 28-day case fatality rates. This comparison includes the MONICA study cities of Augsburg and Bremen, both in West Germany, as well as the cities of Chemnitz, Erfurt, and Zwickau in East Germany (former the German Democratic Republic). The rates were calculated on the basis of all MONICA cases of definite AMI or coronary death aged 35 to 64 years occurring in the respective study populations between 1985 and 1989. All study populations except women in Augsburg showed higher coronary death rates compared to the rates based on the official cause of death statistics (ICD 410-414), but this difference was significant only for men in Chemnitz. In men there were no significant differences in the register-based coronary death rates between these urban areas (160/100,000 in Zwickau to 170/100,000 in Chemnitz) nor in the AMI attack rates (327/100,000 in Augsburg to 363/100,000 in Chemnitz), and consequently no significant center differences in the overall 28-day case fatality. However, the prehospital case fatality was significantly higher in Erfurt (34%) than in Bremen (27%). There were no significant differences in the AMI attack rates in women as well (60/100,000 in Chemnitz to 70/100,000 in Bremen and Erfurt), but the overall 28-day case fatality showed a clear gradient from the East (61-71%) to the West German cities (48-56%) and therefore also the register-based coronary death rates (38-50/100,000 and 34-38/100,000, respectively). However, the higher 28-day case fatality in women found in the MONICA registers in East compared to West Germany is not reflected in the CHD mortality statistics because of a stronger underestimation of the official mortality rates and in East than in West Germany, in particular in women. Nevertheless, the total mortality rates and in most cases also the CVD mortality rates were in women significantly higher in the East German compared to the West German cities. The East German official preunification CHD mortality data cannot be used for national and international comparisons. The results of the MONICA AMI registers in East and West Germany indicate, furthermore, the need to improve coronary care in women in the eastern part of the country. Nevertheless, because of the relatively high AMI attack rate in both parts of Germany primary prevention must generally be intensified.

WHO MONICA Project: risk factors.

The WHO MONICA Project was designed to measure trends and determinants in cardiovascular disease mortality and coronary heart disease and cerebrovascular disease morbidity, and to assess the extent to which these trends are related to changes in known risk factors in 39 collaborative centres in 26 countries. Results of the baseline population surveys are presented. Use of standardized methods allows cross-sectional comparisons to be made of data from the 39 collaborating centres. The proportion of smokers varied between 34-62% among men and 3-52% among women. The median systolic blood pressure (SBP) values varied from 121 mmHg to 145 mmHg in men and from 117 mmHg to 143 mmHg in women. Median diastolic blood pressure (DBP) values varied from 74 mmHg to 91 mmHg in men and from 72 mmHg to 89 mmHg in women. The prevalence of actual hypertension, defined as SBP and/or DBP greater than 159/94 mmHg, or on antihypertensive medication, varied between 8.4% and 45.3% in men and between 12.6% and 40.5% in women. Median serum total cholesterol values varied from 4.1 mmol/l to 6.4 mmol/l in men and from 4.2 mmol/l to 6.4 mmol/l in women. The results show that there is a large variability in the risk-factor patterns among the MONICA populations. They also indicate that populations with low levels of risk factors are in the minority.