March 1, 2016Open Access
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
Key Result
Population-based primary prevention reducing three major risk factors explained 69% (men) and 66% (women) of the 82% and 84% respective reductions in coronary heart disease mortality over 40 years.
Study Design
Type
Observational (n=34,525)
Structured PICO
Do changes in main cardiovascular risk factors through population-based primary prevention reduce coronary heart disease mortality in working-aged men and women?
P
Population
34,525 men and women aged 30-59 years who participated in the national FINRISK studies between 1972 and 2012 in eastern Finland.
I
Intervention
Change in main cardiovascular risk factors (smoking prevalence, serum cholesterol, and systolic blood pressure) through population based primary prevention.
O
Outcome
Predicted and observed age standardised mortality due to coronary heart disease.hard clinical
Population-based primary prevention programs targeting smoking, cholesterol, and blood pressure can achieve substantial reductions in coronary heart disease mortality.
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.
Cite This Study
Jousilahti et al. (Tue,) conducted a observational in Coronary heart disease (n=34,525). Population based primary prevention (change in main cardiovascular risk factors) was evaluated on Predicted and observed age standardised mortality due to coronary heart disease. Population-based primary prevention reducing three major risk factors explained 69% (men) and 66% (women) of the 82% and 84% respective reductions in coronary heart disease mortality over 40 years.