BACKGROUND: The cardiovascular risk factor levels of the population have been assessed in Finland since 1972. In the beginning the surveys were done to evaluate the North Karelia Project, which was a community-based preventive programme. A national cardiovascular disease (CVD) prevention strategy was developed and implemented during the late 1970s. Subsequently, a national cardiovascular risk factors monitoring system was developed to assess the effectiveness of the national strategy. METHODS: Cross-sectional population samples were studied in 1972 and 1977 in North Karelia and Kuopio provinces in eastern Finland. An area in southwestern Finland was included in 1982, followed by the Helsinki metropolitan area in 1992 and Oulu province in northern Finland in 1997. A total of 19 761 men and 20 761 women aged 30-59 participated in the six surveys (1972, 1977, 1982, 1987, 1992, 1997). RESULTS: The serum cholesterol levels of both genders have continuously declined. Systolic blood pressure levels have declined since 1972, but no further decline in diastolic blood pressure was found in 1997. Smoking prevalence among men continued to decline mainly due to an increase in the percentage of never-smokers. For the first time the increase in smoking prevalence among women levelled off and started to decline, mainly because the number of female quitters had increased. CONCLUSIONS: These data suggest that the cardiovascular health programme in Finland has succeeded in decreasing the general risk factor level of the population.
As part of the North Karelia Project a community-based intervention programme to reduce salt consumption was initiated in 1979. The aim of this three-year Salt Project was to evaluate the feasibility and effects of salt reduction in the population. Cross-sectional random population samples, aged 14 to 65 years, were examined both in North Karelia and the reference community in 1979 and 1982. The surveys included among other measurements 24-hour urine collection for Na and K excretion, a salt use index based on reported salt use and a knowledge index concerning salt and health. Changes in the salt intake level were very small. In men Na excretion increased slightly in North Karelia and stayed the same in the reference area. The Na/K ratio in North Karelian men increased significantly. The mean Na excretion level decreased slightly in women in both areas. The reduction in the Na/K ratio in North Karelian women and the decrease in the salt use index in women in both areas were significant. Further analyses showed that in both areas a significant reduction in Na excretion was found but only among normotensive women. There were no changes in the knowledge concerning salt. The feasibility of salt intake reduction was low partly due to insufficient environmental changes.
A model programme for hypertension control in the community has been implemented in North Karelia, Finland, since 1972. The treatment status of the patients was improved and blood pressure levels were reduced during 1972 to 1977. This improvement started to level off during 1977 to 1982, although more than 10% of the population aged 35-64 years were treated with antihypertensive drugs. Several analyses were done to find out which dietary factors contributed to the blood pressure level and to its change in the community. The study material consisted of random samples of the population aged 30-59 years in two counties in Eastern Finland, who participated in the surveys in 1972, 1977 and 1982. The analyses confirmed that high BMI, high fat intake, alcohol drinking and high Na intake were associated significantly with blood pressure and also with its change both in the general population and in hypertensive persons. The high levels of these nutritional factors were also associated with unsatisfactory outcome of drug treatment in the hypertensive patients. Thus, it is likely that nutritional changes that can reduce the levels of BMI, the intake of fat, alcohol, and Na would contribute significantly both to primary prevention and to the effective treatment of elevated blood pressure in the community. In Eastern Finland the levels of alcohol intake have increased both in men and women, BMI increased in men and decreased in women and serum cholesterol levels dropped both in men and women between 1972 to 1982. The results of a community-based programme to reduce salt intake in North Karelia from 1979 to 1982 confirmed that Na intake level is high in Finland. The North Karelia Salt Project showed that it is difficult to reduce salt intake at the community level during a three-year period. A slight reduction in Na intake was seen only in women both in North Karelia and in the reference area. In men Na intake did not decrease. In conclusion our results suggest that primary prevention of hypertension at the community level is not easy and that a well conceived programme for a relatively long time period is needed.
57 couples living in two communities of North Karelia, aged 30-50 years, were randomly allocated to three groups. After a 2-week baseline period group I followed a diet low in fat (23% of energy) with a high polyunsaturated/saturated (P/S) ratio (1 . 0), group II reduced daily salt intake from 192 mmol to 77 mmol, and group III (control group) continued the usual diet. After the 6-week intervention period groups I and II reverted to their usual diets. In group I systolic blood pressure declined from 138 . 4 to 129 . 5 mm Hg and diastolic blood pressure from 88 . 9 to 81 . 3 mm Hg during the intervention period; the values rose during switch-back. The fall was greater among hypertensive than among normotensive subjects. In groups II and III the mean blood pressure changed very little during the study.
To assess the association between dietary acrylamide intake and the risk of cancer among male smokers.
The study consisted of 27,111 male smokers, aged 50-69 years, without history of cancer. They were participants of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study in Finland. The men completed a validated dietary questionnaire and a questionnaire on general background characteristics (including smoking habits) at baseline. Incident cases of cancer were identified through the national Finnish Cancer Registry.
During an average 10.2 year follow-up, 1,703 lung cancers, 799 prostate cancers, 365 urothelial cancers, 316 colorectal cancers, 224 stomach cancers, 192 pancreatic cancers, 184 renal cell cancers, and 175 lymphomas were diagnosed. Dietary acrylamide intake was positively associated with the risk of lung cancer; relative risk (RR) in the highest versus the lowest quintile in the multivariable-adjusted model was 1.18 ((95% confidence interval (CI) 1.01-1.38, p for trend 0.11). Other cancers were not associated with acrylamide intake.
High acrylamide intake is associated with increased risk of lung cancer but not with other cancers in male smokers.
The authors examined prospectively whether dietary folate and other factors known to influence methyl-group availability were associated with the development of exocrine pancreatic cancer within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study cohort. Of the 27,101 healthy male smokers aged 50--69 years who completed a self-administered dietary questionnaire at baseline, 157 developed pancreatic cancer during up to 13 years of follow-up from 1985 to 1997. Cox proportional hazards models were used to estimate the hazards ratios and 95% confidence intervals. The adjusted hazards ratio comparing the highest with the lowest quintile of dietary folate intake was 0.52 (95% confidence interval: 0.31, 0.87; p-trend = 0.05). Dietary methionine, alcohol intake, and smoking history did not modify this relation. No significant associations were observed between dietary methionine, vitamins B(6) and B(12), or alcohol intake and pancreatic cancer risk. Consistent with prior studies, this study shows that cigarette smoking was associated with an increased risk (highest compared with lowest quintile, cigarettes per day: hazards ratio = 1.82; 95% confidence interval: 1.10, 3.03; p-trend = 0.05). These results support the hypothesis that dietary folate intake is inversely associated with the risk of pancreatic cancer and confirm the risk associated with greater cigarette smoking.
The North Karelia Project is a community-based program to reduce the high cardiovascular disease rates in the province of North Karelia in eastern Finland. Dietary changes aimed at reducing serum cholesterol levels were among the main objectives. The evaluation of the program was based on examinations of independent cross-sectional population samples in 1972, 1977, and 1982 in North Karelia and in a matched reference area. A questionnaire was used to measure changes in dietary habits during the program. A major shift from whole to low-fat milk took place in both areas as well as a reduction in the amount of butter used on bread. The net reduction in North Karelia (difference in change compared with the reference area) in the intake of saturated fatty acids from milk and fat spreads used on bread was 20% in men and 14% in women. This reduction was similar in different age, education, and occupational groups suggesting that the dietary intervention had reached the whole community. The validity of the reported dietary changes was confirmed by parallel changes in serum cholesterol levels.
The role of dietary fat in human blood pressure control was studied among 84 middle-aged subjects (mainly couples) in two semirural communities in North Karelia, Finland. The families were randomly allocated into two groups that, after a baseline period of 2 weeks, changed their diet for a 12-week intervention period so that the proportion of energy derived from fats was similarly reduced in both groups, from 38 to 24%, but the polyunsaturated/saturated fatty acid (P/S) ratio was increased--from 0.2 to 0.9 in group I and to 0.4 in group II. After the intervention period, both groups switched back to their usual diet for a period of 5 weeks. During the intervention period, total serum cholesterol was reduced by 16% in group I and 14% in group II. Mean body weight and urinary sodium, potassium, calcium, and magnesium excretion changes were small or nonexistent. Mean systolic blood pressure decreased 4 mm Hg in group I (P less than 0.01) and 3 mm Hg in group II (P less than 0.01), and mean diastolic blood pressure decreased 5 mm Hg (P less than 0.001) and 4 mm Hg (P less than 0.01), respectively. The reductions were reversed during the switch-back period (P less than 0.01). These results confirm previous findings of the blood-pressure-reducing effect of a low-fat/high-P/S diet. Although a number of possible confounding factors can be ruled out, the dietary constituent accounting for the blood pressure change cannot be ascertained definitely. The results showed no significant further blood pressure reduction with more than a moderately increased P/S ratio when the saturated fat intake was markedly reduced.