Background/objectivesThe 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 28days case fatality on a 25-year period and examine sex differences in lethality. MethodsThis 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. ResultsThe 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. ConclusionsFavourable 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 15years of the register; after that, it stabilized.