• Pekka Jousilahti, Tiina Laatikainen, Markku Peltonen, Katja Borodulin, Satu Männistö, Antti Jula, Veikko Salomaa, Kennet Harald, Pekka Puska, and Erkki Vartiainen.
• National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland pekka.jousilahti@thl.fi.
• BMJ. 2016 Mar 1; 352: i721.

ObjectiveTo estimate how much changes in the main risk factors of cardiovascular disease (smoking prevalence, serum cholesterol, and systolic blood pressure) can explain the reduction in coronary heart disease mortality observed among working aged men and women in eastern Finland.DesignPopulation based observational study.SettingEastern Finland.Participants34,525 men and women aged 30-59 years who participated in the national FINRISK studies between 1972 and 2012.InterventionsChange in main cardiovascular risk factors through population based primary prevention.Main Outcome MeasuresPredicted and observed age standardised mortality due to coronary heart disease. Predicted change was estimated with a logistic regression model using risk factor data collected in nine consecutive, population based, risk factor surveys conducted every five years since 1972. Data on observed mortality were obtained from the National Causes of Death Register.ResultsDuring the 40 year study period, levels of the three major cardiovascular risk factors decreased except for a small increase in serum cholesterol levels between 2007 and 2012. From years 1969-1972 to 2012, coronary heart disease mortality decreased by 82% (from 643 to 118 deaths per 100,000 people) and 84% (114 to 17) among men and women aged 35-64 years, respectively. During the first 10 years of the study, changes in these three target risk factors contributed to nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than predicted. In the last 10 years of the study, about two thirds (69% in men and 66% in women) of the reduction could be explained by changes in the three main risk factors, and the remaining third by other factors.ConclusionReductions in disease burden and mortality due to coronary heart disease can be achieved through the use of population based primary prevention programmes. Secondary prevention among high risk individuals and treatment of acute events of coronary heart disease could confer additional benefit.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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