Decline in ischaemic heart disease in Iceland and change in risk factor levels.

doi:10.1136/bmj.302.6789.1371

BMJ 1991;302:1371-1375 (8 June), doi:10.1136/bmj.302.6789.1371

Decline in ischaemic heart disease in Iceland and change in risk factor levels.

N Sigfusson, H Sigvaldason, L Steingrimsdottir, I I Gudmundsdottir, I Stefansdottir, T Thorsteinsson, G Sigurdsson

Icelandic Heart Association, Reykjavik.

OBJECTIVE--To monitor trends in mortality and morbidity dueto ischaemic heart disease and compare these with observed levelsof risk factors from population surveys. DESIGN--Analysis oftrends in death rates from ischaemic heart disease in Icelandcompared with expected rates computed from population surveys.Risk factor levels together with beta factors obtained fromCox's regression analysis were used to compute expected deathrates. Trends in morbidity due to acute myocardial infarctionwere assessed and secular trends in dietary consumption comparedwith trends in cholesterol concentrations. SETTING--Reykjavik,Iceland (total population 250,000; over half the populationlive in Reykjavik). SUBJECTS--12,814 randomly selected residentsin the Reykjavik area aged 45-64 (6623 men, 6191 women; 72%and 80% of those invited). MAIN OUTCOME MEASURES--Age adjustedrates of myocardial infarction and deaths from ischaemic heartdisease. Expected risk from risk factor levels (smoking, totalserum cholesterol concentration, systolic blood pressure) ateach unique survey visit. RESULTS--Mortality from ischaemicheart disease has decreased by 17-18% since 1970. During 1981-6the myocardial infarction attack rate in men under 75 decreasedby 23%. A decrease occurred in the level of all three majorrisk factors after 1968. The fall in the serum cholesterol concentrationcoincided with a reduction in consumption of dairy fat and margarine.The calculated reduction in risk for the age group 45-64 wasabout 35%, which was closely similar to the observed decreasein mortality due to ischaemic heart disease in that age group.CONCLUSION--The reduction in mortality from ischaemic heartdisease was substantially due to a decreased incidence of myocardialinfarction and could be attributed largely to the reductionin risk factors.

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