News Release

Pop(ulation) Culture: Aggressive Cholesterol-Lowering Strategy = Fewer Heart Attacks

Peer-Reviewed Publication

American Heart Association

DALLAS, March 24 -- By lowering blood cholesterol levels by just 10 percent in a population, the result could be a 20 percent reduction in heart attack deaths suggest authors of a study published in today's Circulation: Journal of the American Heart Association.

Finnish scientists examined their own country's change over a 20-year period which saw a dramatic decrease in heart attack mortality.

"In the past 25 years, mortality from heart attack in the middle-aged population of eastern Finland has decreased to less than half its previous level," says the study's lead author Pekka Jousilahti, M.D. of the National Public Health Institute in Helsinki, Finland. "About half of the decrease in heart attack deaths associated with risk factor change was explained by the decrease in cholesterol levels alone."

For example, in the study examining 27,721 men and women between the ages of 30-59, the proportion of people with a very high cholesterol level decreased from 16 percent in 1972 to just 3 percent in 1992. Men who showed a 10 percent overall decrease in cholesterol had a 19.7 percent decrease in predicted heart attack death rates. Women who showed a 10 percent decrease had a 16.7 percent decrease in predicted heart attack rates.

Researchers say that the dramatic change resulted from a community-based population strategy of heart attack prevention which was effective in decreasing blood cholesterol levels among the entire population. They believe that effective prevention of heart attack can be attained through targeting the general population in addition to those at high-risk for heart attack because of high cholesterol levels.

The scientists say that Western societies such as the United States -- where about 37.7 million adults have cholesterol levels of 240 milligrams/deciliter (mg/dL) or higher -- could most benefit from this type of cholesterol reduction strategy.

"The potential public health impact of community-based control of cholesterol is much greater than what can be achieved through targeting only high-risk people," Jousilahti says. "A balance of both high-risk and population strategies are needed for effective prevention of heart attack."

In using a population strategy, the starting point is an assessment of the health situation, the major health problems and the related risk factors in the population. Intervention is targeted to the entire community or a majority of the population. Health education is most often used, but other methods such as legislative regulations and development and promotion of healthy products are also used.

"The population strategy has been criticized for being either ineffective or for not using a sufficiently well-targeted intervention," says Jousilahti. "But there are some successful examples, such as what happened in Finland."

The methods used to reduce high cholesterol levels in eastern Finland -- where many people were afflicted with high blood cholesterol -- were mainly health education and the development and promotion of food products that are low in saturated fat. Health education campaigns were conducted using television, newspapers, the healthcare system, schools, and voluntary health organizations.

"The primary target of measurement was not to screen high-risk subjects for individual intervention, but rather to motivate people to adopt a healthier lifestyle that was promoted in the community," says Jousilahti.

During the 20-year span between 1972-1992, a considerable downward shift occurred in the cholesterol levels of the Finnish population. Average cholesterol levels decreased from 262 mg/dL to about 228 mg/dL among men and from 259 mg/dL to 212 mg/dL among women.

The scientists also found that the risk of heart attack -- when compared to those who had blood cholesterol levels of less than 193 mg/dL -- was nearly three-fold greater among people with cholesterol levels between 251 and 305 mg/dL and five-fold greater among those having cholesterol levels greater than 309 mg/dL.

Co-authors are Erkki Vartiainen, M.D.; Juha Pekkanen, M.D.; Jaakko Tuomilehto, M.D.; Jouko Sundvall, M.Sc; Pekka Puska, M.D.

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NR 98-4878 (Circ/Jousilahti)

Media advisory: Dr. Jousilahti can be reached by phone at 011 358 9 47448 623 or by fax at 011 358 9 47448 338. (Please do not publish numbers.)

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