Pekka Puska

Socioeconomic Differences in Trends in Coronary Heart Disease Mortality and Risk Factors in Finland

Finland has witnessed a rapid decline in coronary heart disease (CHD) mortality among working-age men and women since the end of the 1960s. Among men aged 35–64, age-standardized CHD mortality declined by 50% from 1971–1972 to 1990–1991. The trend has been similar among women. Concomitant with the declining mortality, there have been improvements in the levels of CHD risk factors. In the provinces of North Karelia and Kuopio, risk-factor surveys have been carried out among independent random samples of the middle-aged population every 5 years since 1972. In these surveys, improvements have been observed in mean serum total cholesterol concentration, diastolic blood pressure, and smoking. Although overall changes have been favorable, relative differences in CHD mortality between educational groups have widened, especially in the 1980s in Finland. In risk factors, the decline in serum cholesterol and in the proportion of hypertensives among both sexes, and in smoking among men, has been similar in all educational groups. However, trends in body mass index have diverged between educational groups, and among women, smoking has changed from a habit of the more educated to a habit of the less educated.

Results of a Community Nutritional Programme as part of a Comprehensive Cardiovascular Control Program (The North Karelia Project)

North Karelia project is a comprehensive cardiovascular community programme in Eastern Finland where the incidence of coronary heart disease is highest ever reported in the world. The Project was launched in 1972 after a petition from the local population. The main objective has been to reduce the frequency of cardiovascular diseases among the whole population. As intermediate objectives were chosen (a) reduction of smoking, serum cholesterol and blood pressure in the community. The intervention period was 5 years, 1972–1977.