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

TLDR

The study aims to quantify how changes in serum cholesterol, blood pressure, and smoking explain the decline in ischemic heart disease mortality and assess each factor’s relative contribution. Using logistic regression on cross‑sectional survey data from 1972–1992 in Finland, the authors predicted mortality changes from risk factor levels and compared them to observed mortality trends. Predicted declines of 44 % (men) and 49 % (women) closely matched observed declines of 55 % and 68 %, indicating that most of the mortality reduction is attributable to changes in the three main risk factors.

Abstract

<h3>Abstract</h3> <b>Objectives</b>: 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. <b>Design</b>: 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. <b>Setting</b>: North Karelia and Kuopio provinces, Finland. <b>Subjects</b>: 14 257 men and 14 786 women aged 30–59 randomly selected from the national population register. <b>Main outcome measures</b>: 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. <b>Conclusion</b>: 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.