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Monica: multinational monitoring of trends and determinants in cardiovascular disease cohort component


: To establish a large European cohort study of CHD and stroke in men and in women in all centres with follow-up data in the MONICA Project: the estimated number of CHD events is 8,385 and stroke events is 2,983 by the end of 1997. To assess the predictive ability of the genetic polymorphisms of candidate genes for the subsequent development of CHD or stroke.
To provide a scientific dissemination facility of the MONICA database in the form of CD files of data and also as a Monograph.

The MONICA Project was established in the early 1980s in many Centres around the world to MONItor trends in Cardiovascular diseases (coronary heart disease (CHD) event registration is obligatory, stroke registration optional), and tolerate these to risk factor changes in the population over a ten year period. It was set up to explain the diverse trends in cardiovascular disease mortality, which were observed from the 1960s onwards, particularly a decline in CHD in the United States. Such trends are plainly apparent within MONICA. There is a total of 17 Centres in 9 out of the 15 European Union member countries (Belgium2, Denmark 1, Finland 1, France 3, Germany 3, Italy 2, United Kingdom 2, Spain1 and Sweden 2): there are 6 centres in 4 European third countries: Czech Republic, Lithuania, Poland, and Russia. Iceland (1 Centre) can be a partner and, therefore, eligible for funding, and Switzerland (1 Centre) is negotiating for similar status.

There are a further 7 centres elsewhere in the world: 3 in Austral Asia, 2 in North America and one each in China and the former Yugoslavia. The 10 year data collection is now complete and the major 10-yearanalyses are underway. The completion of MONICA is supported through a grant under BIOMED 2 (PL951693) grant, which became available from 1 June 1996. The Project's 2 major hypotheses relating to risk factors, CHD trends and case fatality, are being addressed in the final analyses. A secondary hypothesis for stroke is exploring the relationship between stroke and coronary events. There are, however, a number of other aspects of MONICA, which can profitably be examined. Although MONICA is cross-sectional in its design a number of centres have assembled cohorts, which have been recruited to the standard MONICA Protocol and followed for events. Thus a very large MONICA cohort (198,000), mainly within Europe, has been assembled which has generated a large number of CHD and stroke events which will allow an exploration of risk factors and the development of disease from this. It will be possible to derive a European risk factor score for coronary heart disease and stroke. In addition, over the past decade or so, some of the centres have collected DNA within these cohorts and we estimate that there are almost 2,000 cases for study out of a cohort of approximately 95,000 participants. A nested case control approach is proposed, selecting two controls for each case. This will require the participation of several genetic laboratories and, because standardised baseline risk factor data are available will allow an assessment of gene-environment interactions. In addition, funding for the MONICA Data Centre in Helsinki is sought, as it will collate the various data sets for the participating centres. There remain 2 other tasks to be fulfilled to complete this phase of MONICA: the archival of the MONICA database, and the production of a WHO MONICA monograph to place the entire Project in context.


Mulhouse Building, Grosvenor Road
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Participants (4)

Institut National de la Santé et de la Recherche Médicale
17,Rue Du Fer À Moulin
75005 Paris
166,Mannerheimintie 166
00300 Helsinki
Saint Stephen's Green 123
University of Dundee
United Kingdom

DD1 9SY Dundee