Abstract
In France, the mortality and case fatality rates of coronary heart disease follow a decreasing North–East–South gradient. The aim of the study was to evaluate the contribution of major cardiovascular risk factors to this gradient. To this end, the results of the third population survey of the WHO–MONICA Project conducted in three French geographically contrasted regions (the Urban Community of Lille in the North, the district of Bas-Rhin in the East and the district of Haute-Garonne in the South) are presented. One thousand seven hundred seventy-eight men and 1730 women aged 35–64years were randomly selected from the electoral rolls. Major coronary heart disease risk factors (hypertension, hypercholesterolemia, low high-density lipoprotein (HDL)-cholesterol, obesity, smoking, physical inactivity, diabetes) were studied. The results show that the distribution of major coronary heart disease risk factors is heterogeneous among geographical areas in France. However, the proportion of subjects with more than three risk factors is higher in the North than in the other regions and the number of subjects with no risk factor is higher in the South than in the other areas. This distribution of risk factors among regions supports the hypothesis that accumulation of coronary heart disease risk factors contributes to the decreasing North–East–South gradient of cardiovascular mortality rates in France.
Similar content being viewed by others
References
Tuomilehto J, Kuulasmaa K, Torppa J. WHO-MONICA Project: Geographic variation in mortality from cardiovascular diseases. Baseline data on selected population characteristics and cardiovascular mortality. World Health Stat Q 1987; 40: 171–184.
Tunstall-Pedoe H, Kuulasmaa K, Mähönen M, et al. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10 year results from 37 WHO-MONICA Project populations. Lancet 1999; 353: 1547–1557.
Uemura K, Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Stat Q 1988; 41: 155–178.
Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the WHO-MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994; 90: 583–612.
The WHO-MONICA Project (monitoring trends and determinants in cardiovascular disease): A major international collaboration. WHO-MONICA Project Principal Investigators. J Clin Epidemiol 1988; 41: 105–114.
Diabetes Mellitus: Report of a WHO Study Group. Geneva, WHO Tech Rep Ser, no. 727, 1985.
Arterial hypertension. Report of a WHO expert committee. WHO Tech Rep Ser 1978; 7–56.
Association of Finnish Internists (FCS). Diagnostics and treatment of hypercholesterolemia and other hyperlipidemia among adult people. Duodecim 1988; 104: 1425–1438.
Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev 1988; 10: 87–121.
Abramson JH, Gofin R, Habib J, Pridan H, Gofin J. Indicators of social class. A comparative appraisal of measures for use in epidemiological studies. Soc Sci Med 1982; 16: 1739–1746.
Dang Tran P, Leclerc A, Chastang JF, Goldberg M. Regional disparities in cardiovascular risk factors in France: A five year analysis of the Gazel cohort. Eur J Epidemiol 1999; 14: 535–543.
Rose G, Marmot MG. Social class and coronary heart disease. Br Heart J 1981; 45: 13–19.
Lang T, Ducimetiere P. Premature cardiovascular mortality in France: Divergent evolution between social categories from 1970 to 1990. Int J Epidemiol 1995; 24: 331–339.
Helmert U, Shea S, Herman B, Greiser E. Relationship of social class characteristics and risk factors for coronary heart disease in West Germany. Public Health 1990; 104: 399–416.
Kushi LH, Lenart EB, Willett WC. Health implications of Mediterranean diets in light of contemporary knowledge. 2. Meat, wine, fats, and oils. Am J Clin Nutr 1995; 61(6 Suppl): 1416S-1427S.
Danet S, Richard F, Montaye M, et al. Unhealthy effects of atmospheric temperature and pressure on the occurence of Myocardial Infarction and Coronary Deaths-A 10 year survey. The Lille-WHO-MONICA Project. Circulation 1999; 100: E1–E7.
Dannenberg AL, Keller JB, Wilson PW, Castelli WP. Leisure time physical activity in the Framingham Off-spring Study. Description, seasonal variation, and risk factor correlates. Am J Epidemiol 1989; 129: 76–88.
Erikssen G, Liestol K, Bjornholt J, Thaulow E, Sandvik L, Erikssen J. Changes in physical fitness and changes in mortality. Lancet 1998; 352: 759–762.
Jousilahti P, Toumilehto J, Vartiainen E, et al. Importance of risk factor clustering in coronary heart disease mortality and incidence in eastern Finland. J Cardiovasc Risk 1995; 2: 63–70.
Yusuf HR, Giles WH, Croft JB, Anda RF, Casper ML. Impact of multiple risk factor profiles on determining cardiovascular disease risk. Prev Med 1998; 27: 1–9.
Rose G. Sick individuals and sick populations. Int J Epidemiol 1985; 14: 32–38.
The pooling project research group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of the pooling project. J Chronic Dis 1978; 31: 201–306.
Wu LL. Review of risk factors for cardiovascular diseases. Ann Clin Lab Sci 1999; 29: 127–133.
Frishman WH. Biologic markers as predictors of cardiovascular disease. Am J Med 1998; 104: 18S-27S.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cottel, D., Dallongeville, J., Wagner, A. et al. The North–East–South gradient of coronary heart disease mortality and case fatality rates in France is consistent with a similar gradient in risk factor clusters. Eur J Epidemiol 16, 317–322 (2000). https://doi.org/10.1023/A:1007678526840
Issue Date:
DOI: https://doi.org/10.1023/A:1007678526840