Five-year trend in serum HDL-lipoprotein cholesterol in the Finnish population aged 25-64 years. A suggestion of an increase.

High density lipoprotein cholesterol (HDLC) was measured in the population surveys carried out in Finland in 1982 and 1987. The mean (+/- SD) of HDLC for men aged 25-64 years was 1.23 +/- 0.32 mmol/l in 1982 and 1.30 +/- 0.33 mmol/l in 1987, the increase being 5.7%. Respective values in women were 1.46 +/- 0.33 mmol/l and 1.58 +/- 0.35 mmol/l, an increase of 8.2%. The increase was significantly greater in women than in men (P less than 0.001). The prevalence of low HDLC (less than or equal to 0.9 mmol/l) fell from 13.5 to 9.6% in men and from 3.2 to 1.4% in women. Factors associated with low HDLC were the history of ischemic heart disease (IHD), diabetes and hypertension in both sexes and the positive family history of IHD in women. Subjects with low HDLC also had higher body mass index (BMI), waist-hip ratio and serum total cholesterol (TC) concentration than subjects with normal HDLC. Changes in BMI, waist-hip ratio, alcohol intake, leisure time physical activity, prevalence of smoking or in the dietary variables recorded, did not explain the increase in HDLC.

The development of hypertension care in Finland from 1982 to 1987.

The development of hypertension care in Finland was evaluated using the data from two independent population samples of the FINMONICA Project comprising 9350 and 6250 persons examined in 1982 and 1987, respectively. The sampling frame was the population aged 25 to 64 years in the provinces of North Karelia and Kuopio in eastern Finland and in the Turku-Loimaa region in south-western Finland. During the 5-year period, the mean systolic blood pressure levels decreased in all of the groups except the North Karelian men. Mean diastolic blood pressure did not change significantly. The proportion of hypertensive men with adequately controlled blood pressure increased from 22.6 to 29.4% [difference 6.8%, 95% confidence interval (Cl) for the difference 2.4-11.2] during 1982-1987. At the same time, the proportion of hypertensive men unaware of their condition fell from 30 to 20.9% (difference -9.1%, 95% Cl for the difference -13.4- -4.8). There was corresponding falls for women from 39.2 to 41.3% (difference 2.1%, 95% Cl for the difference -3.1-7.3) and from 15.4 to 13.1% (difference -2.3%, 95% Cl for the difference 1.4- -6.0), respectively. Thus, obvious progress had taken place, although the situation remained far from satisfactory. The possibility of overly aggressive treatment of hypertension was also investigated. It was found that only less than 10% of the middle-aged hypertensive men treated with drugs had diastolic pressures less than or equal to 85 mmHg, suggesting that this might not be an issue of concern at community level.

Environmental chemicals and changes in sex ratio: analysis over 250 years in finland.

It has been proposed that environmental chemicalization is responsible for the recent decline in male ratio, but these speculations are based on statistics going back only a few decades. The objective of this study was to evaluate whether Finnish long-term data are compatible with the hypothesis that the decrease in the ratio of male to female births in industrial countries is caused by environmental factors. We analyzed the sex ratio of births from the files of Statistics Finland and all live births in Finland from 1751 to 1997. Running averages of 9 years (1751-1904) or 5 years (1905-1997) were analyzed for sex ratios. Additionally, to identify potential explanations for the findings, births from 1990 to 1997 were correlated with various family parameters. We found an increase in the proportion of males from 1751 to 1920; this was followed by a decrease and interrupted by peaks in births of males during and after World War I and World War II. None of the family parameters (paternal age, maternal age, age difference of parents, birth order) could explain the time trends. The turning point of male proportion precedes the period of industrialization or the introduction of pesticides or hormonal drugs, rendering a causal association unlikely. Moreover the trends are similar to those observed in other countries with worse pollution and much greater pesticide use.

Fifteen-year trends in coronary risk factors in Finland, with special reference to North Karelia.

The North Karelia Project, a major demonstration programme for coronary heart disease (CHD) prevention, was begun in an eastern province of Finland in 1972. A number of national CHD prevention activities have been undertaken, quite a few of them since 1977. This paper reports the 15-year changes in CHD risk factors (serum cholesterol, blood pressure, and smoking) in North Karelia and in the original reference area of the project, and more recent changes in a third area in southwestern Finland. The results are based on well-standardized, comparable surveys of cross-sectional populations, aged 30 to 59 years. The results indicate that risk factors reduced markedly in North Karelia from 1972-1977, to a lesser extent from 1977-1982, and only a little from 1982-1987. There was also a decline in the reference area during the first ten years (1972-1982) but the changes did not exceed those in North Karelia and during the second phase, from 1982-1987, risk factor changes were minor. Risk factor levels in the third area in southwestern Finland changed little from 1982-1987. Present serum cholesterol and blood pressure levels in North Karelia are still higher than in southwestern Finland, but smoking is less common among North Karelian men. These findings are discussed in the light of the recent information on Finnish dietary changes and CHD mortality; their bearing on the need for new cardiovascular disease prevention activities in Finland is also discussed.

Prevalence of diabetes mellitus and impaired glucose tolerance in the middle-aged population of three areas in Finland.

The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) was determined in a random sample of the population aged 45-64 years in three areas of Finland. The two-hour oral glucose tolerance test was repeated in subjects whose first test suggested abnormal glucose tolerance. In the final classification, based on the results of the two tests, the age-standardized prevalence of diabetes, according to the WHO criteria was 5.7% (95% confidence interval (CI): 4.3-7.1) in men and 4.6% (95% CI: 3.6-5.0) in women. The prevalence of IGT was 3.1% (95% CI: 2.1-4.1) in men and 5.1% (95% CI: 3.9-6.3) in women. Among those aged 55-64 years the prevalence was 6.9% in men and 7.5% in women. The prevalence of diabetes and IGT were not different between the three areas. The age-specific mean values of fasting and two-hour blood concentrations and the 90th percentiles of the blood glucose distributions were also not different between the areas. The prevalence of IGT and diabetes increased with age more steeply among women than men. The median of fasting blood glucose did not change, but the 90th percentile increased with increasing age. The entire distribution of two-hour blood glucose shifted towards higher values with ageing, but the major increase was seen for the 95th percentile. The majority of the diabetic subjects were aware of their condition. The awareness was better among men than women.

Body fat distribution in the Finnish population: environmental determinants and predictive power for cardiovascular risk factor levels.

STUDY OBJECTIVE: The aim was to examine (1) whether health habits are associated with body fat distribution, as measured by the waist/hip girth ratio, and (2) to what extent environmental factors, including anthropometric characteristics, explain the variability in levels of cardiovascular risk factors. DESIGN: The study was a population based cross sectional survey, conducted in the spring of 1987 as a part of an international research project on cardiovascular epidemiology. SETTING: The survey was conducted in three geographical areas of eastern and south western Finland. SUBJECTS: 2526 men and 2756 women aged 25-64 years took part in the study, corresponding to a survey participation rate of 82%. MEASUREMENTS AND MAIN RESULTS: In men, waist/hip ratio showed stronger associations with exercise (Pearson's r = -0.24), resting heart rate (r = 0.10), alcohol consumption (r = 0.07), smoking (r = 0.05), and education (r = -0.23) than did body mass index. Jointly, exercise, resting heart rate, alcohol consumption, education, and age explained 18% of variance in male waist/hip ratio, but only 9% of variance in male body mass index. In women, environmental factors were more predictive for body mass index than for waist/hip ratio, with age and education being the strongest determinants. Waist/hip ratio and body mass index were approximately equally strong predictors of cardiovascular risk factor levels. The additional predictive power of waist/hip ratio over and above body mass index was tested in a hierarchical, stepwise regression. In this conservative type of analysis the increase in explained variance uniquely attributable to waist/hip ratio was 2-3% for female and 1-2% for male lipoprotein levels, and less than 0.5% for female and 0-2% for male blood pressure values. CONCLUSIONS: The distribution of abdominal obesity in Finland is significantly influenced by health habits and sociodemographic factors in both men and women. This in turn is obviously one reason for the relatively small "independent" effect of body fat distribution on cardiovascular risk factor levels.

Body fat distribution, serum lipoproteins and blood pressure in middle-aged Finnish men and women.

The association of body fat distribution as measured by the ratio of waist to hip girth (WHR) to age, to serum total cholesterol and HDL-cholesterol and to blood pressure was studied in a population-based sample of 2461 men and 2768 women aged 25 to 64 years not treated with cardiovascular drugs. In men, the relationships of age with WHR and age with body mass index (BMI) were similar, an increase levelling at the age of about 50 years. In women, BMI increased linearly, but WHR exponentially with age. In both sexes, age-adjusted WHR and BMI associated positively with non-HDL cholesterol, and with systolic and diastolic blood pressure, and inversely with HDL-cholesterol and the HDL/non-HDL cholesterol ratio. WHR and BMI were independently related to several cardiovascular risk factors. HDL-cholesterol concentration was 19% lower in men, and 17% lower in women who belonged to the upper tertile of both WHR and BMI, than in the subjects in the lower tertiles of WHR and BMI. Age-adjusted WHR and BMI also predicted fasting and 2-hour post-challenge blood glucose values in women aged 45 to 64 years, but not in men. The WHR provides additional information on elevated cardiovascular risk factors in cross-sectional analysis among middle-aged men and women independently of BMI. The measurement of WHR in large-scale risk factor surveys should be recommended, in order to assess the independent contribution of WHR to the risk of cardiovascular disease, and to find out the importance of WHR for the prevention of chronic diseases.

Trends in cardiovascular risk factors in treated and untreated hypertensive and normotensive Finnish subjects, 1982-1987.

We compared cardiovascular disease (CVD) risk factors and their changes in drug-treated hypertensive subjects with those of untreated hypertensive and normotensive subjects in the FINMONICA population surveys in 1982 and 1987. The hypertensive subjects had, whether treated or not, a significantly higher mean serum total cholesterol concentration than the normotensive subjects. The mean serum high density lipoprotein (HDL) cholesterol concentration was significantly lower in treated hypertensive subjects than in the untreated ones or in normotensive subjects. From 1982 to 1987 the mean serum total cholesterol decreased 2% (95% confidence interval (CI) -4.8%, +0.9%) and 4.7% (-7.2%, -2.0%) and HDL-cholesterol increased 4.5% (+8.0%, +0.1%) and 9.9% (+13.5%, +6.3%) in treated hypertensive men and women, respectively. On the other hand, the mean body mass index (BMI) of treated hypertensive men increased significantly during the study period, and also the alcohol consumption and the prevalence of smoking tended to increase.

Smoking and leanness: evidence for change in Finland.

Many studies have shown smokers to weigh less than non-smokers, which is plausible given the metabolic effects of cigarette smoke. The interrelation between smoking and relative body weight and its change over time were analysed by using data from Finnish population based surveys from 1982 and 1987. Among both men and women the inverse association between smoking and body mass index was clearly weakened between 1982 and 1987. In 1987 among men aged 25-44 smoking was positively related to body mass index. Moreover, the relation between smoking and waist to hip girth ratio was positive in both sexes at all ages. Years of smoking was nevertheless confirmed as a significant inverse predictor of relative weight. A cluster of unfavourable health habits, including high consumption of alcohol and saturated fats, especially emerged among younger smokers. This may have been due to different selection of smokers in Finland, where smoking increasingly seems to be a form of deviant or risk taking behaviour. It is concluded that at a population level the metabolic effects of smoking seem to be increasingly overridden by several other unfavourable health behaviours of smokers.

Serum cholesterol distribution, measurement frequency and cholesterol awareness in three geographical areas of Finland.

The serum cholesterol distribution in three geographical areas of Finland was examined during the first and the second FINMONICA surveys in 1982 and 1987. The mean serum cholesterol concentration changed very little during this observation period. In 1987 the population mean (+/- SD) was 6.12 +/- 1.26 mmoll-1 in men aged 25-64 years and 5.96 +/- 1.28 mmoll-1 in women. Only approximately 20% of the Finns had their serum cholesterol at the level which is regarded as desirable by recent international recommendations. The frequency of cholesterol measurements increased in Finland, especially in North Karelia, from 1972 to 1977 but since then no further increase has taken place. From 1982 to 1987 the proportion of subjects whose cholesterol level was over 6.5 mmoll-1 and who reported knowing that their cholesterol was high increased from 27% to 31% in men and from 24% to 34% in women, respectively. It is concluded that approximately 45% of the adult Finnish population is at moderately increased risk and further 33% at considerably increased risk of coronary heart disease because of the elevated serum cholesterol.