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Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland

BMJ 1994; 309 doi: (Published 02 July 1994) Cite this as: BMJ 1994;309:23
  1. E Vartiainen,
  2. P Puska,
  3. J Pekkanen,
  4. J Toumilehto,
  5. P Jousilahti
  1. National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, FIN-00300 Helsinki, Finland
  1. Correspondence to: Dr Vartiainen.
  • Accepted 7 April 1994


Objectives: To estimate the extent to which changes in the main coronary risk factors (serum cholesterol concentration, blood pressure, and smoking) explain the decline in mortality from ischaemic heart disease and to evaluate the relative importance of change in each of these risk factors.

Design: Predicted changes in ischaemic heart disease mortality were calculated by a ligistic regression model using the risk factor levels assessed by cross sectional population surveys, in 1972, 1977, 1982, 1987, and 1992. These predicted changes were compared with observed changes in mortality statistics.

Setting: North Karelia and Kuopio provinces, Finland.

Subjects: 14 257 men and 14 786 women aged 30–59 randomly selected from the national population register.

Main outcome measures: Levels of the risk factors and predicted and observed changes in mortality from ischaemic heart disease. Results — The observed changes in the risk factors in the population from 1972 to 1992 predicted a decline in mortality from ischaemic heart disease of 44% (95% confidence interval 37% to 50%) in men and 49% (37% to 59%) in women. The observed decline was 55% (51% to 58%) and 68% (61 to 74) respectively.

Conclusion: An assessment of the data on the risk factors for ischaemic heart disease and mortality suggests that most of the decline in mortality from ischaemic heart disease can be explained by changes in the three main coronary risk factors.


    • Accepted 7 April 1994
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