title: Primary prevention and risk factor reduction in coronary heart disease mortality among working aged men and women in eastern Finland over 40 years: population based observational study.
abstract: OBJECTIVE
  To estimate how much changes in the main risk factors of cardiovascular disease (smoking prevalence, serum cholesterol, and systolic blood pressure) can explain the reduction in coronary heart disease mortality observed among working aged men and women in eastern Finland.
  
  
  METHODS
  Population based observational study.
  
  
  METHODS
  Eastern Finland.
  
  
  METHODS
  34,525 men and women aged 30-59 years who participated in the national FINRISK studies between 1972 and 2012.
  
  
  METHODS
  Change in main cardiovascular risk factors through population based primary prevention.
  
  
  METHODS
  Predicted and observed age standardised mortality due to coronary heart disease. Predicted change was estimated with a logistic regression model using risk factor data collected in nine consecutive, population based, risk factor surveys conducted every five years since 1972. Data on observed mortality were obtained from the National Causes of Death Register.
  
  
  RESULTS
  During the 40 year study period, levels of the three major cardiovascular risk factors decreased except for a small increase in serum cholesterol levels between 2007 and 2012. From years 1969-1972 to 2012, coronary heart disease mortality decreased by 82% (from 643 to 118 deaths per 100,000 people) and 84% (114 to 17) among men and women aged 35-64 years, respectively. During the first 10 years of the study, changes in these three target risk factors contributed to nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than predicted. In the last 10 years of the study, about two thirds (69% in men and 66% in women) of the reduction could be explained by changes in the three main risk factors, and the remaining third by other factors.
  
  
  CONCLUSIONS
  Reductions in disease burden and mortality due to coronary heart disease can be achieved through the use of population based primary prevention programmes. Secondary prevention among high risk individuals and treatment of acute events of coronary heart disease could confer additional benefit.
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland pekka.jousilahti@thl.fi.
authors.forename: Pekka
authors.initials: P
authors.lastname: Jousilahti
authors.affiliation: University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Laatikainen
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Katja
authors.initials: K
authors.lastname: Borodulin
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Männistö
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Jula
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Veikko
authors.initials: V
authors.lastname: Salomaa
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Kennet
authors.initials: K
authors.lastname: Harald
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Pekka
authors.initials: P
authors.lastname: Puska
authors.affiliation: National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Vartiainen
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000517:prevention & control*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods; D012042:Registries; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D012907:Smoking / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL