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Authors: E Vartiainen, T Laatikainen, M Peltonen, A Juolevi, et al.

Reference: Int J of Epidemiol. 2010; 39:504-518
http://ije.oxfordjournals.org/cgi/content/abstract/dyp330

Reviewer: Joaquin Barnoya, MD, MPH, Contributing Editor, ProCor; Research Assistant, Professor of Surgery, Washington University in St. Louis, Missouri, USA; Director, Research and Education, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala

Reviewer comments: The well-known Finish experience continues to yield large population benefits. Opposed to investing large amounts of resources in expensive "new" treatments, a community based program can lead to a significant decrease in coronary heart disease (CHD) mortality. In addition to the benefits on CHD mortality, quality of life and other chronic diseases (diabetes and cancer) should also benefits from such programs.

Purpose of study: In 1972 a comprehensive community-based intervention program was launched in North Karelia to reduce the burden of CHD. The program has been gradually implemented nationwide. Population risk factor surveys have been carried out at 5-year intervals. This paper aims to describe the trends in cardiovascular disease risk factors and their contribution to the declining CHD trend in Finland.

Location of study: Finland

Study design: For each survey (1972-2007), a random sample was drawn from the national population register (aged 25-74 years). Together with the mailed questionnaire, participants were invited to a health examination. Blood pressure, height and weight, and smoking status have been recorded. In addition, blood samples have been collected since 1972. Risk factor contribution on the mortality decline was assessed with logistic regression analysis.

Results: Cholesterol levels have declined significantly since 1972. In North Karelia, cholesterol declined 21% in men and 23% in women. The decline has been less pronounced (5%) in the past 5 years. Blood pressure has also declined. In women, systolic blood pressure declined until 1997 and then between 2002 and 2007 (1.8 mmHg, p<0.05). Regarding diastolic blood pressure, both genders experienced a similar decline from 1972-2002, but not from 2002-2007. Among men, smoking declined until 1997, but not thereafter when it experienced an increase until 2007 (current prevalence, 30%). Among women, smoking prevalence has increased slowly until 2002, but no further increase from 2002-2007 (current prevalence, 21%). In men, body mass index continuously increased, except for the 2002-2007 period. Women have experienced a slight increasing trend since 1982. Current obesity prevalence for both genders is 21%. The decrease in cholesterol (1.54 mmol/l), diastolic blood pressure (8.7 mmHg), and smoking (15% points) explain 60% reduction in CHD mortality in middle aged men (observed decline was 80%).