[Prevention of cardiovascular diseases: the Finnish experience and current situation]

25 years ago Finland had the highest coronary mortality in the world. The North Karelia Project has carried out a coordinated, community-based intervention in order to reduce the prevalence of cardiovascular risk factors (hypercholesterolemia, smoking and hypertension). The evaluation has used standardized cross sectional population surveys at 5-year intervals. From 1972 to 1992, among men aged 30-59 years, the prevalence of smoking changed from 52 to 32%, the mean total cholesterol from 7.1 to 5.8 mmol/l, the mean blood pressure from 147/92 to 143/84 mmHg and the age-adjusted mortality rate has reduced for ischemic heart disease by 48% and for cancer by 42%. During the past 30 years the geographical distribution of cardiovascular mortality in Europe has substantially changed. The highest rates that were reported in the mid 1960's in Finland today occur in Central and Eastern Europe. The epidemy of cardiovascular disease in postcommunist countries seems to be only partially associated with high prevalence of the three "classical" risk factors (hypercholesterolemia, smoking, hypertension). It is probable that other, as yet unrecognized risk factors have potentiated the classical ones. Psychosocial stress and specific nutritional deficiencies of antioxidants leading to oxidative stress could belong to such "new" risk factors in Slovakia and in other postcommunist countries. (Tab. 2, Fig. 3, Ref. 36.)