Glasgow and Belfast top heart attack list

Glasgow and Belfast have topped a poll as two cities with some of the worst rates of heart attacks in the world, according to the results of a 10 year study published in the Lancet.

The first definitive results of the World Health Organisation's Monica (cardiovascular disease monitoring) project, revealed that of 37 centres studied in 21 countries, Glasgow had the worst heart attack rate among women and the second worst among men. Belfast was second and fourth respectively.

The cities across four continents were chosen largely because of their worryingly high rates of heart disease. Only North Karelia, in Finland, long notorious for the high cholesterol levels of its inhabitants, had a worse record for heart attacks in men than Glasgow.

When the study began, said Hugh Tunstall-Pedoe of the cardiovascular epidemiology unit of Dundee university, cholesterol in Finland was extremely high, partly because of the tendency of people on farms to drink two pints of milk a day and partly because they boiled their coffee, which brings out a cholesterol-raising substance from the beans.

Dietary changes have succeeded in bringing cholesterol levels down more steeply than anywhere else, and yet the Finns still top the league table. 'Their decline is very creditable, but I think an awful lot of people are under the impression that Finland has conquered heart disease. That is not the case,' Professor Tunstall-Pedoe said.

Glasgow's problems come from high levels of smoking, and a poor diet causing high cholesterol and blood pressure. The intake of fruit and vegetables, which protect against cancer and heart disease, is low and the population generally does not take enough exercise.

The study reveals a remarkable difference in heart attack rates between northern and southern Europe. Catalonia in Spain and Brianza in Italy have some of the lowest rates. Toulouse, in southern France, is with them, and markedly healthier than either Lille or Strasbourg. An editorial in the Lancet by Joseph Alpert of the department of medicine at Arizona university, says this is the so-called 'French paradox'.

Heart disease in southern France is low in spite of a diet heavy in cholesterol. But fruit and vegetable consumption is high, and Glasgow university studies have suggested anti-oxidants called flavonols in fruit, vegetables and red wine may play a part.

The Monica project's aim was to discover whether the fall in deaths in the west was due to a decrease in heart attacks or better medical care for the victims.

The Lancet finds that there has been a drop in the number of heart attacks probably because of the increasing western awareness of the importance of diet and exercise.

But as western habits spread in some of the developing world, it is becoming clear that heart disease is on the increase there.