In this issue the MONICA (monitoring trends and determinants in cardiovascular disease) team from Toulouse reports on myocardial infarction trends in south west France between 1985 and 1993.1 There were 3263 events in men and there appeared to be an annual decrease of around 2% in both event rate and mortality rates. Twenty eight day case fatality fell by about 3% per year for first events and by 6% for recurrent events. The confidence intervals, however, are very wide around these estimates. The authors have concluded that the decrease in myocardial infarction mortality was predominantly attributable to reduction in case fatality and, by inference, improvements in acute management. It should be noted that there were few events in women.1

The Toulouse report updates an earlier description of the same population for the period 1985-90,2 and provides local detail as part of the much larger MONICA project recently reported elsewhere.3 Curiously, the attack rates and case fatality rates in the present report are quite different from those in the earlier one.2 In …