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American Journal of Epidemiology Advance Access originally published online on September 8, 2005
American Journal of Epidemiology 2005 162(8):764-773; doi:10.1093/aje/kwi274
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

ORIGINAL CONTRIBUTIONS

Explaining the Decline in Coronary Heart Disease Mortality in Finland between 1982 and 1997

Tiina Laatikainen1, Julia Critchley2, Erkki Vartiainen1, Veikko Salomaa1, Matti Ketonen3 and Simon Capewell4

1 Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
2 International Health Research Group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
3 The Central Hospital of North Karelia, Joensuu, Finland
4 Department of Public Health, University of Liverpool, Liverpool, United Kingdom

Correspondence to Dr. Tiina Laatikainen, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland (e-mail: tiina.laatikainen{at}ktl.fi).

In Finland since the 1980s, coronary heart disease mortality has declined more than might be predicted by risk factor reductions alone. The aim of this study was to assess how much of the decline could be attributed to improved treatments and risk factor reductions. The authors used the cell-based IMPACT mortality model to synthesize effectiveness of treatments and risk factor reductions with data on treatments administered to patients and trends in cardiovascular risk factors in the population. Cardiovascular risk factors were measured in random samples of patients in 1982 (n = 8,501) and 1997 (n = 4,500). Mortality and treatment data were obtained from the National Causes of Death Register, Hospital Discharge Register, social insurance data, and medical records. Estimated and observed changes in coronary heart disease mortality were used as main outcome measures. Between 1982 and 1997, coronary heart disease mortality rates declined by 63%, with 373 fewer deaths in 1997 than expected from baseline mortality rates in 1982. Improved treatments explained approximately 23% of the mortality reduction, and risk factors explained some 53–72% of the reduction. These findings highlight the value of a comprehensive strategy that promotes primary prevention programs and actively supports secondary prevention. It also emphasizes the importance of maximizing population coverage of effective treatments.

cardiac surgical procedures; coronary disease; drug therapy; mortality; primary prevention; risk factors

Abbreviations: CABG, coronary artery bypass grafting; CHD, coronary heart disease


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