DECLINE OF CORONARY HEART-DISEASE MORTALITY IN FINLAND DURING 1983 TO1992 - ROLES OF INCIDENCE, RECURRENCE, AND CASE-FATALITY THE FINMONICA-MI REGISTER STUDY

Background The rate of coronary heart disease (CHD) mortality in easte rn Finland has been the highest in the world. The official mortality s tatistics suggest. however, that it has declined by 60% during the pas t 20 years. The aim of the present study was to examine the contributi ons of incidence, recurrence, and case fatality of coronary events to the trends in CHD mortality in three areas of Finland. Methods and Res ults Population-based myocardial infarction registers have been operat ing in the provinces of North Karelia and Kuopio in eastern Finland an d the Turku/Loimaa area in southwestern Finland from 1983 to 1992. Dur ing this 10-year period, each suspected coronary event in persons 35 t o 64 years of age was evaluated for registration. Of these, 13 566 ful filled the criteria of myocardial infarction or coronary death. Almost one fourth (22.4%) of the coronary events were sudden, out-of-hospita l deaths. Among men, the average change in mortality was -7.1% per yea r (95% confidence interval. -8.4% to -5.8%) in North Karelia, -5.0% pe r year (-7.0% to -3.0%) in Kuopio, and -4.9% per year (-8.2% to -1.6%) in Turku/Loimaa. Among women. the corresponding changes were -5.6% (- 11.1% to -0.1%), -4.4% (-8.1% to -0.7%), and -8.1% (-13.0% to -3.2%). In eastern Finland, the decline in CHD mortality was clue to a decline in recurrent coronary events but also in the incidence of first coron ary events, whereas in southwestern Finland, the decline in case-fatal ity tate had the major role. Conclusions The decline in CHD mortality rate in Finland appears to be the result of a successful combination o f primary and secondary prevention measures and improvements in acute coronary care.