From the National Public Health Institute, Department of Epidemiology and
Health Promotion (P.J., E.V., J.T., P.P.), Helsinki, Finland; National Public
Health Institute, Unit of Environmental Epidemiology (J.P.), Kuopio, Finland;
and National Public Health Institute, Department of Biochemistry (J.S.),
Helsinki, Finland.
Correspondence to Dr Pekka Jousilahti, National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, FIN-00300 Helsinki, Finland. E-mail pekka.jousilahti{at}ktl.fi
Background—The purpose of the
present study was to assess the implications of
cholesterol distribution and its change on coronary
heart disease (CHD) mortality and disease prevention at a
population level.
Methods and Results—In five independent risk factor surveys
(1972, 1977, 1982, 1987, and 1992) in eastern Finland, serum
cholesterol was measured in 27 721 randomly selected men
and women aged 30 to 59 years. The association between
cholesterol level and CHD risk and the prediction of the
effect of different prevention strategies was estimated by use of
logistic regression models. The entire cholesterol
distribution of the population shifted markedly toward lower levels
between 1972 and 1992. The proportion of subjects with a very high
cholesterol level (
Conclusions—The community-based population strategy in
cardiovascular disease prevention was effective in
decreasing cholesterol levels among the entire population,
including the subjects with the highest cholesterol values.
The balanced application of both high-risk and population strategies is
needed for the effective prevention of CHD.
© 1998 American Heart Association, Inc.
Current Perspectives
Serum Cholesterol Distribution and Coronary Heart Disease Risk
Observations and Predictions Among Middle-aged Population in Eastern Finland
8.0 mmol/L), also decreased
markedly, from 16% to 3%. The risk of CHD death among subjects with
cholesterol 8.0 mmol/L was 
5-fold that of those
individuals having cholesterol <5.0 mmol/L.
Nevertheless, because CHD risk increases continuously as serum
cholesterol increases, and because the number of people
having only slightly or moderately increased serum
cholesterol was large, most CHD deaths occurred among them.
A 10% reduction in cholesterol levels in the entire
population would subsequently reduce CHD mortality by 20%, as much as
an effective treatment as a 25% decrease in serum
cholesterol among all subjects with cholesterol
>6.5 mmol/L and four times more than similar treatment of all
subjects with cholesterol 8.0 mmol/L.
Key Words: cholesterol • coronary disease • mortality • prevention
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