The aim of this study is to describe the 21 year trends in myocardial infarction among middle-aged inhabitants in the city of Turku, in southwestern Finland. Since 1972 the coronary register in Turku has monitored acute coronary events leading to hospital admission or death, first according to the methods of the World Health Organization Heart Attack Register Study, and since 1982 according to the methods of the WHO MONICA. From 1972 to 1992 we registered 7374 events of suspected myocardial infarction, of which 6045 events occurring in inhabitants of Turku aged 35-64 years, fulfilled the criteria for myocardial infarction. Within 28 days, 2266 coronary events proved fatal. During the 21-year period, the incidence of definite myocardial infarction fell by 55% in men and by 62% in women, and coronary mortality fell by 66 and 81%, respectively. From 1972 to 1982, total mortality and coronary mortality decreased in parallel. Later on, the decrease in total mortality levelled off, even though coronary mortality fell still steeper, because mortality from external causes of death increased. The favourable long-term trends reflect favourable changes in total cholesterol and blood pressure in the middle-aged population, and the improvement in the treatment of myocardial infarction. Further efforts are needed to enhance this trend, but also to reduce total mortality among middle-aged people.
Comment In: Eur Heart J. 1996 Oct;17(10):1455-68909894
A questionnaire survey of all members of the Psoriasis Society of the Greater Helsinki area was carried out during March and April 1984 in order to determine the course of psoriasis. 1517 (85.4%) of the members responded; 1050 of them had psoriasis with skin symptoms only (psoriasis; P) and 400 had also joint symptoms (psoriatic arthritis; PA). In two thirds, the psoriasis had started before the age of 30 years. Skin lesions were more frequent in the PA-group than in the P-group, and more severe in men than in women in both groups. Of the 400 with PA, about 70% had moderate to very severe discomfort in their joints. Most of the patients had experienced their first joint symptoms at the age of 20 to 49 years. In the majority of the patients with PA the skin symptoms begun before the joint symptoms; in 7% the joint symptoms had preceded the skin symptoms; and in 10% both symptoms had begun simultaneously.
Atrial fibrillation (AF) is a risk factor for stroke. This study was undertaken to determine the influence of AF on the mortality of stroke patients and on the causes of death after a stroke event.
Patients with first ischemic stroke who were .35 to 74 years old and registered in the FINMONICA stroke register during 1982 through 1992 were analyzed (n = 6912). There were 642 patients with AF (9.3%) (mean age, 67 years) and 6270 patients without AF (90.3%) (mean age, 63 years). The association between AF and stroke mortality was investigated by use of logistic regression and Cox proportional hazards models.
Mortality was higher in the AF group both at 28 days (19.5% versus 14.4%, P
The objective of this study was to determine the association of atrial fibrillation (AF) with stroke recurrence and mortality and with the causes of death in ischemic stroke patients aged 75 years and older.
A population-based study.
The cities of Turku and Kuopio in Finland.
The study cohort consisted of 2635 consecutive patients aged 75 years and older, with a first ischemic stroke, registered in the FINMONICA Stroke Register.
28-day and 1-year stroke mortality, causes of death, and recurrence of stroke.
There were 767 stroke patients with AF (mean age 82.2) and 1868 patients without AF (mean age 81.4). Mortality was higher in the AF group both 28 days (33.9% vs 28.1%, P = .003) and 1 year after the attack (52.7% vs 43.0%, P
Comment In: J Am Geriatr Soc. 1997 Nov;45(11):1404-59361669
To investigate to what extent the changes in traditional risk factors (total cholesterol, smoking, hypertension) explain the changes in socioeconomic (defined by occupational class and household income) differences in cardiovascular mortality in Finland during the past 20 years.
Study population comprised 14,642 men and women aged 35-64 years who were selected from population-based FINRISK surveys in 1987, 1992, 1997 or 2002 in three areas of Finland. The 1982 and 1987 FINRISK cohorts were used to determine a model for the probability of cardiovascular death based on risk factor values at the baseline for each socioeconomic group. These predicted changes in cardiovascular mortality were then contrasted with observed mortality rates in different socioeconomic groups to determine the contribution of the changes in risk factors to changes in actual mortality.
We found that among men during 1987-97, when risk factor levels were improving in all socioeconomic groups, the model explained 29-44% of the observed mortality decline. The risk factors explained a larger part of the decline among lower socioeconomic groups. During the period 1997-2002 the risk factor levels stopped improving in all socioeconomic groups but observed mortality rates kept declining. The predicted mortality rates were 16-34% of the observed rates during the period 1987-2002.
Changes in traditional risk factors no longer provide a good explanation of the changes in cardiovascular mortality and its socioeconomic differences. However, risk factors did explain the cardiovascular mortality decline among lower socioeconomic groups.
To compare the long-term trends in mortality and attack rate of ischaemic heart disease in North Karelia, Finland, and in Kaunas, Lithuania, from 1971 to 1987.
Data on routine mortality statistics were obtained from the Central Statistical Office of Finland and from the Central City Archives of Kaunas. In addition, data from the community based myocardial infarction registers were used. The registers used similar diagnostic criteria and had operated in both areas during the entire study period.
The province of North Karelia in Finland and the city of Kaunas in Lithuania.
The target populations were the people of North Karelia and Kaunas aged 35-64 years.
Mortality from ischaemic heart disease and the attack rate of acute myocardial infarction.
In North Karelia mortality from ischaemic heart disease and the attack rate of acute myocardial infarction declined steeply both in men and women. This decline was accompanied by a decrease in total mortality. In Kaunas, both mortality and the attack rate increased in men but remained unchanged in women. In 1985 to 1987, age standardised total mortality per 100,000 inhabitants was similar in the two populations in men (1081 (95% confidence interval (CI) 1013 to 1149), in North Karelia; 1082 (95% CI 1032 to 1132), in Kaunas). The proportional mortality from ischaemic heart disease was considerably higher in North Karelia (40%) than in Kaunas (28%). In women, age standardised total mortality was lower in North Karelia (350 (95% CI 312-388)) than in Kaunas (440 (95% CI 413 to 467)). The proportional mortality from ischaemic heart disease in women was also higher in North Karelia (28%) than in Kaunas (13%).
Despite the remarkable decline in the occurrence of ischaemic heart disease, it still remains the most important cause of premature mortality in North Karelia. In Kaunas ischaemic heart disease mortality and attack rate increased in men. Experiences from successful cardiovascular disease prevention programmes in western countries, such as the North Karelia Project, should be exploited to prevent an increasing epidemic of ischaemic heart disease in eastern Europe.
Cites: Acta Med Scand. 1975 Mar;197(3):211-61124671
Cites: Eur Heart J. 1992 May;13(5):577-871618197
Cites: J Clin Epidemiol. 1989;42(1):17-242643674
Cites: Acta Med Scand Suppl. 1966;460:1-3925226858
Cites: World Health Stat Q. 1988;41(3-4):155-783232406
Cites: Int J Epidemiol. 1987 Sep;16(3):373-63667034
Cites: World Health Stat Q. 1985;38(2):142-624036160
Cites: Am J Epidemiol. 1989 Apr;129(4):655-682923116
Decline in out-of-hospital coronary heart disease deaths has contributed the main part to the overall decline in coronary heart disease mortality rates among persons 35 to 64 years of age in Finland: the FINAMI study.
Out-of-hospital deaths constitute the majority of all coronary heart disease (CHD) deaths and are therefore of considerable public health significance.
We used population-based myocardial infarction register data to examine trends in out-of-hospital CHD deaths in Finland during 1983 to 1997. We included in out-of-hospital deaths also deaths in the emergency room and all deaths within 1 hour after the onset of symptoms. Altogether, 3494 such events were included in the analyses. The proportion of out-of-hospital deaths of all CHD deaths depended on age and gender. In the age group 35 to 64 years, it was 73% among men and 60% among women. These proportions did not change during the study. The annual average decline in the age-standardized out-of-hospital CHD death rate was 6.1% (95% CI, -7.3, -5.0%) among men and 7.0% (-10.0, -4.0%) among women. These declines contributed among men 70% and among women 58% to the overall decline in CHD mortality rate. In all, 58% of the male and 52% of the female victims of out-of-hospital CHD death had a history of symptomatic CHD. Among men with a prior history of myocardial infarction, the annual average decline in out-of-hospital CHD deaths was 5.3% (-7.2, -3.2%), and among men without such history the decline was 2.9% (-4.4, -1.5%). Among women, the corresponding changes were -7.8% (-14.2, -1.5%) and -4.5% (-8.0, -1.0%).
The decline in out-of-hospital CHD deaths has contributed the main part to the overall decline in CHD mortality rates among persons 35 to 64 years of age in Finland.
The rate of coronary heart disease (CHD) mortality in eastern Finland has been the highest in the world. The official mortality statistics suggest, however, that is has declined by 60% during the past 20 years. The aim of the present study was to examine the contributions of incidence, recurrence, and case fatality of coronary events to the trends in CHD mortality in three areas of Finland.
Population-based myocardial infarction registers have been operating in the provinces of North Karelia and Kuopio in eastern Finland and the Turku/Loimaa area in southwestern Finland from 1983 to 1992. During this 10-year period, each suspected coronary event in persons 35 to 64 years of age was evaluated for registration. Of these, 13,566 fulfilled the criteria of myocardial infarction or coronary death. Almost one fourth (22.4%) of the coronary events were sudden, out-of-hospital deaths. Among men, the average change in mortality was -7.1% per year (95% confidence interval, -8.4% to -5.8%) in North Karelia, -5.0% per year (-7.0% to -3.0%) in Kuopio, and -4.9% per year (-8.2% to -1.6%) in Turku/Loimaa. Among women, the corresponding changes were -5.6% (-11.1% to -0.1%), -4.4% (-8.1% to -0.7%), and -8.1% (-13.0% to -3.2%). In eastern Finland, the decline in CHD mortality was due to a decline in recurrent coronary events but also in the incidence of first coronary events, whereas in southwestern Finland, the decline in case-fatality rate had the major role.
The decline in CHD mortality rate in Finland appears to be the result of a successful combination of primary and secondary prevention measures and improvements in acute coronary care.
Stroke mortality has decreased during the last decade in many industrialized countries, but there has been no clear evidence for a decline in the incidence of stroke. The present study analyzes the trends in the incidence, mortality and case-fatality of stroke in Finland from 1983 to 1989. We used data from the FINMONICA stroke register, a community based register collecting information on all suspected stroke cases aged 25-74 in three geographical areas of Finland. Annual attack rate, incidence, mortality and case-fatality rates were calculated for all strokes and for different subcategories of stroke. A linear regression model was applied to calculate the yearly trends of these rates. In men, the attack rate of stroke was 336/100,000 in 1983 and 310/100,000 in 1989 (-8% during the observation period); incidence declined from 269/100,000 in 1983 to 236/100,000 in 1989 (-12%); mortality declined from 82/100,000 to 64/100,000 (-22%), and case-fatality declined from 25% to 21% (-18%). Also among women similar declining trends were observed (-11%, -13%, -16%, and -10% respectively), but they were not statistically significant. In both incidence and mortality of stroke, the decline was seen in all age groups. Incidence and mortality of cerebral infarction declined similarly to all strokes. A large fall in the incidence (-24% in both men and women) and mortality (-38% in men and -27% in women) of subarachnoid haemorrhage was also observed. An increasing trend, although not significant, was instead observed for cerebral haemorrhage. First stroke and especially first cerebral infarction contributed most to the decline in case-fatality. The availability of computerized brain tomography improved from 18% in 1983 to 60% in 1989. We observed a fall in the incidence, mortality, and case-fatality of stroke during 1983-1989. Among the subtypes of stroke, cerebral infarction contributed most to the decline, but the data suggested also a declining trend in the incidence and mortality of subarachnoid haemorrhage, observed now for the first time in Finland since the 1960s. The fall in the incidence of stroke was not as steep during the 1980s as it was during the 1970s; Finland is anyhow the only European country which has reported a decreasing trend in stroke incidence during the 1980s. We need now to investigate how much the decline in the classical risk factors for stroke observed in Finland during the last two decades predicts the observed trends.
To examine patterns of ever smoking among Finnish adults by gender and birth cohort from 1978 to 2001, with special emphasis on the possible effects of the 1976 Tobacco Control Act (TCA).
The data were derived from independent, annual cross sectional postal surveys among 15-64 year olds (n = 91,342), average response rate 75%. For the analyses 13 five year birth cohorts from 1916 to 1980 were constructed. Birth cohort variations in ever regular smoking were first examined graphically, and then logistic models were used to test the impact of the TCA.
Among men there was a decrease in smoking from older to younger cohorts. For women an increase in smoking was observed between successive cohorts. A clear decline in the prevalence of ever smokers concurrent with the TCA was found among both men and women.
The smoking behaviour trends across successive birth cohorts suggest the impact of tobacco policy in decreasing smoking initiation in youth. These findings thus support the acceptability and effectiveness of antismoking and smoke free policy measures in society.
Cites: Ann Epidemiol. 2003 Feb;13(2):105-1012559669
Cites: Eur J Cancer Prev. 2003 Feb;12(1):57-6212548111
Cites: Soc Sci Med. 1987;25(8):875-813686116
Cites: Am J Public Health. 1989 Feb;79(2):152-72913832
Cites: Br J Addict. 1992 Jan;87(1):103-101543930
Cites: J Epidemiol Community Health. 1993 Feb;47(1):54-88436896
Cites: BMJ. 1994 Oct 8;309(6959):901-117755693
Cites: BMJ. 1994 Oct 8;309(6959):923-77950662
Cites: BMJ. 1996 Oct 12;313(7062):907-88876091
Cites: J Public Health Med. 1997 Jun;19(2):203-79243437