Gender differences in acute myocardial infarction, twenty-five years registration Yves Coppieters ⁎, Philippe Collart, Alain Levêque Department of Epidemiology and Health Promotion, School of Public Health, Université Libre de Bruxelles (U.L.B.), Route de Lennik 808, CP 596, 1070 Brussels, Belgium abstract article info Article history: Received 28 April 2010 Received in revised form 21 January 2011 Accepted 14 April 2011 Available online xxxx Keywords: Ischaemic cardiopathies Register Cardiovascular disease MONICA Belgium Background/objectives: The French-speaking Community of Belgium has set up a register of ischaemic cardiopathies (1983–2007). The aim consists in analyzing the evolution of fatal and non-fatal acute coronary events rates as well as the 28 days case fatality on a 25-year period and examine sex differences in lethality. Methods: This register assures a standardized procedure according to the MONICA criteria. For each period, we present attack rates and trends analysis. Hospital lethality takes again in-patients and community lethality is calculated starting from all the cases. Results: The total attack rate is rather stable between 1983 and 2007 for women (from 12 to 19 per 10,000 residents). For men, there is a distinct decline of the total attack rate since 1991 till 1993 (63 to 43 per 10,000 residents). We systematically observe a reduction in risk between men and women according to the age. For each 5-year period, this risk decreases significantly with age and this difference is strongest during the periods 1993–1997 and 1998–2002. The analysis shows also a significant decline in lethality between the 1983–1987 and 1993–1997 periods. Among women, lethality is systematically higher than in men in spite of the presence or the absence of antecedents of myocardial infarction. Conclusions: Favourable evolutions in the attack rates of acute coronary events in the study population appear clearly on the 25-year period of observation. The whole lethality rates decreased during the first 15 years of the register; after that, it stabilized. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Cardiovascular diseases are the primary causes of mortality in Belgium. In Europe, coronary mortality rates show two opposed evolutions during the last 15 years. In Northern and Western countries, mortality decreased by 1 to 3% per year. Inversely, Eastern countries revealed increasing coronary mortality during the same period [1,2]. Sex differences in clinical features, treatment and prognosis after acute myocardial infarction (AMI) have been a popular issue and a considerable number of studies about that were reported. Many studies [3–6] about sex differences in mortality after AMI have consistently demonstrated that women have higher mortality than men. But other studies [7–9] have reported that there is no significant difference in the mortality between men and women after adjusting for differences in age and other risk factors. Register studies are designed to obtain information on the frequency of the disease under investigation [1]. These long-term studies require a standardized procedure, particularly if a comparison between registers is intended [10]. The European MONICA study (Multinational monitoring of trends and determinants of cardiovas- cular disease) also demonstrated a North–South gradient in coronary mortality [11,12]. Two Belgian units participated in the project: Ghent in the northern Flemish-speaking region and Charleroi, the largest city in the southern region of the French-speaking community of Belgium [13,14]. To monitor these important and problematic health aspects, Belgium set up in 1983 a register of acute coronary events in Charleroi, after a feasibility study in 1982 [4]. This register is part of the MONICA project coordinated by the World Health Organization. The register has been working for 25 years, in a standardized way. It allows to collect all suspect cases of myocardial infarction through a system involving all hospitals likely to hospitalize patients residing in Charleroi with a history of CHD. Additionally, the register allows analysis of death certificates. The aim of this publication consists in analyzing the evolution of fatal and non-fatal acute coronary events rates as well as the 28 day case fatality over a 25-year period and examine sex differences in lethality. The aim of the register is to contribute to the promotion of the quality in medical care given by health professional generalists and specialists and to improve the health system management and plan prevention programs [10]. 2. Materials and methods Several publications have described the study methodology [4–13]. Key elements and the description of specific analyses realised in the framework of this 25-year analysis are presented. International Journal of Cardiology xxx (2011) xxx–xxx ⁎ Corresponding author. Tel.: +32 2 555 40 93; fax: +32 2 555 40 49. E-mail address: yves.coppieters@ulb.ac.be (Y. Coppieters). IJCA-13457; No of Pages 6 0167-5273/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2011.04.012 Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard Please cite this article as: Coppieters Y, et al, Gender differences in acute myocardial infarction, twenty-five years registration, Int J Cardiol (2011), doi:10.1016/j.ijcard.2011.04.012