In this issue Norris and colleagues contrast their cardiological perspective of coronary heart disease mortality in 1994–95 in Brighton, South Glamorgan, and York with statistics based on death certificates.1 They also compare coronary event rates and case fatality with British studies from the 1960s and 1970s, and with data from 1985–87 from 38 WHO MONICA project populations worldwide, including Belfast and Glasgow.2

Designation of their three centres in England and Wales as the United Kingdom heart attack study (UKHAS) seems immodest in view of activity elsewhere2 ,3 but they do provide data from areas of the UK missing from the 10 year MONICA project. MONICA, although drafted in London in 1979–81,4 despite later regrets, evinced little local interest in the funding of an English or Welsh centre, leaving Scotland and Northern Ireland supporting the initiative. Given the separateness of UKHAS and the authors’ emphasis on cardiology versus epidemiology, how has it fared, and how comparable is it with other heart attack registers?

Coronary heart attack registration involves mixing fatal and non-fatal attacks. Manipulation of diagnostic criteria produces an astonishing range of results for attack rate and case fatality.5 Naive clinicians and politicians believe that survival rates mirror treatment alone, but the recent advent of performance indicators and league tables6 has …