The North Karelia project

Abstract

A comprehensive community program for control of cardiovascular disease (CVD) was carried out from 1972 to 1977 in the county of North Karelia, Eastern Finland, an area with exceptionally high CVD rates. The primary aim was to reduce CVD mortality and incidence rates among the population through general reduction of smoking rates, serum cholesterol levels (general dietary changes), and elevated blood pressures, and through promoting secondary prevention. The program activities were closely integrated with community organizations, and community involvement was emphasized. The aim of the evaluation was to assess the feasibility, effects, process, costs, and other consequences of the program. Representative population samples were studied at the beginning and end of the period in North Karelia and a matched reference area. Smoking, serum cholesterol levels, and blood pressure levels decreased in North Karelia, even when adjusted for the changes in the reference area. The respective net reduction of estimated coronary heart disease (CHD) risk (based on a logistic model) was 17% for men and 12% for women. Acute myocardial infarction (AMI) and stroke incidence rates as well as CVD and total mortality rates decreased significantly during the program in North Karelia. The changes in mortality, however, were not significantly different from those in the reference area. A significant net reduction took place in CVD and total disability rates in North Karelia. The program costs were relatively low and several associated positive changes were observed, for example, concerning emotional problems. The overall positive experiences of the project were further supported by the obvious nationwide impact through practical applications and more general influence on national policy decisions. In the meantime, further developments in the community continue to be monitored in order to fully assess the program effects.