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Observational Study
. 2016 Mar 1:352:i721.
doi: 10.1136/bmj.i721.

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

Pekka Jousilahti  1 , Tiina Laatikainen  2 , Markku Peltonen  3 , Katja Borodulin  3 , Satu Männistö  3 , Antti Jula  3 , Veikko Salomaa  3 , Kennet Harald  3 , Pekka Puska  3 , Erkki Vartiainen  3
Affiliations
Observational Study

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

Pekka Jousilahti et al. BMJ. .

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.

Design: Population based observational study.

Setting: Eastern Finland.

Participants: 34,525 men and women aged 30-59 years who participated in the national FINRISK studies between 1972 and 2012.

Interventions: Change in main cardiovascular risk factors through population based primary prevention.

Main outcome measures: 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.

Conclusion: 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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Age standardised mortality from coronary heart disease in 1969-2012 (logarithmic scale), for working aged men and women (age 35-64 years) in eastern Finland
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Fig 2 Predicted and observed reduction (%) in coronary heart disease mortality in men aged 35-64 years, 1972-2012
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Fig 3 Predicted and observed reduction (%) in coronary heart disease mortality in women aged 35-64 years, 1972-2012
See this image and copyright information in PMC

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