Speech Title: The power of interventions – the example of Finland: The North Karelia Project
Erkki Vartiainen, MD, Ph.D. has been Professor (emeritus) and Assistant Director General in National Institute for Health and Welfare in Finland. The main responsibility of his department has been non-communicable disease prevention. His main research interest has been cardiovascular disease prevention by risk factors and lifestyle changes. He has over 600 publications in international and national scientific journals. He has been working as a co-principal investigator in the North Karelia Project. Consult for World Bank, WHO and EU in chronic diseases prevention in several developed and developing countries. He was Visiting Scientist at CDC in the US in 1989-90, Visiting Professor at the University of Edinburgh in 2000-2001, he had Adjunct Academic Status as a Professor 2011-2013 and Doctor of Science (honorary) in Flinders University, Australia. He was a member of executive board in Finnish Diabetes Association, chairperson of the central council in Asthma and Allergy Federation and chairperson of the Finnish Association for Substance Abuse Prevention, and chairperson of National Nutrition Council in Finland. He was director of WHO Collaborative Centre on NCD prevention in Finland.
Finland in the 1960s, and especially North Karelia in the eastern part of the country, had the highest cardiovascular mortality in the world. The classical cardiovascular risk factors were all common, but serum cholesterol level was extremely high because of the very high intake of saturated fats, mainly from dairy products. The North Karelia Project was started as a comprehensive preventive program to reduce serum cholesterol levels by reducing the intake of saturated fats and increasing the intake of polyunsaturated fats in the whole population. Cross-sectional population surveys were done in North Karelia and nearby Kuopio province every 5 years starting in 1972. After 1982, surveys were started also in other areas in Finland. Blood cholesterol was measured from serum samples, and diet was assessed by a questionnaire in all surveys—since 1982 by 3-day food record, since 1997 by 24-hour recall, and since 2002 by 48-hour recall. Between 1972 and 2012, the population in North Karelia reduced serum cholesterol from 6.92 mmol/l to 5.46 mmol/l (21%) in men and from 6.81 mmol/l to 5.37 mmol/l (21%) in women. In men, serum cholesterol level reduced more in North Karelia than in the reference province of Kuopio during the first 5 years from 1972 to 1977. Since that time, changes in serum cholesterol level have been very similar in different parts of the country. Saturated fats were reduced from 20% of energy intake to 12% in 2007 but increased from 2007 to 2017 to 14%. Cardiovascular mortality declined 82% and 40 % of that decline was explained by serum cholesterol reduction. In conclusion, serum cholesterol reduction by dietary changes is feasible on the population level but requires active work and large-scale cooperation between all the meaningful sectors in the society and cholesterol reduction quickly reducing to cardiovascular mortality.