Cardiovascular disease. Background of the project “Northern Karelia”

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Отрывок из книги “Проект «СЕВЕРНАЯ КАРЕЛИЯ»: от Северной Карелии до проекта национального масштаба”. Напомним, уже почти сорок лет весь мир наблюдает за уникальным экспериментом финнов. Финляндия увеличила среднюю продолжительность жизни своего населения на 13 лет и снизила смертность от сердечно-сосудистых заболеваний в семь раз, сократив в рационе животные жиры и переведя на здоровую соль с Potassium and low sodium first separate region and then the entire population.

D., Martti Karvonen.

In Finland already in the 19th century there were cases of angina with fatal outcome. They are suffering both sexes, and not necessarily elderly. Angina there was a terrible harbinger heart attack.

Ischemic heart disease as a separate diagnosis steel clearly set in hospitals in the 1930-ies.

In 1947 a young professional demographic, Vaino Kannisto published his doctoral thesis on mortality in Finland and pointed out that since the 19th century mortality in the Eastern regions was higher than in the West, and that the cases death from heart disease was particularly widespread. In fact, the figures for Eastern Finland led the international tables mortality data from heart disease. I was one of those who have read a brief overview of the thesis Kannisto in the Finnish medical journal “Duodecim”. I woke up the interest to this problem. In 1945, as a young laboratory assistant at the Institute of physiology at the University of Helsinki, I took on the challenging task to organize physiological research in connection with National championship fellers, in which participants cut down and raskrashival trees for four days. Used only hand saws and axes. Since the 1950s the physiology of labour and occupational health in the center of my career. At that time in the Eastern regions of Finland, where the first place of employment was occupied by the forest industry, mortality from cardiovascular disease was the highest. This is despite the fact that it was considered that physical education and sport improve health and prolong life. Working at the Institute of hygiene of labor of the young physiologist has become increasingly clear that something serious is missed in the scientific understanding of the problem.

During my first trip to the United States in the spring of 1954 I visited the Laboratory of physiological hygiene University of Minnesota in Minneapolis. I had a short conversation with its Director, Ancel Kasam, just returned from a trip to Italy. In 1952 he published his hypothesis on the chain of causal relationships: the fat in foods high in cholesterol in blood plasma – atherosclerosis and its clinical manifestations in cardiovascular system. This undertaking became the main impetus for bringing together East and West in 1956 in the first study of risk factors for coronary system.

Finland was selected two areas with different mortality rates: one in the East, the second – on the South-West. Clinically examined 16 healthy men and women, and intensively studied ordinary family diet. The results supported the hypothesis that cholesterol: saturated fat consumption from food as cholesterol was high by international standards, and higher in the East than in the southwest.

Results from these multidisciplinary research experience encouraged to register and the time factor. Thus began a long study of two different populations of men aged 40-59 years at the beginning of the study, sleeps as in a previous study, in the East and South-West of the country. Another test in the five-year and ten-year intervals confirmed the significant difference between the risks coronary disease. The project “East-West” began in 1959 as a unique component “Research of seven countries”, during which the same group of men was examined at regular time intervals, allowing to track the incidence of coronary system and mortality for 25 years.

In Finland a 30-year survey period of this group occurred in 1989, and cases of hospitalization and death of its participants are registered so far and, at least until the expiration of 40 years. In the study, “East-West” in addition to nutrition and cholesterol was investigated and other potential sources of risk, such as blood pressure, Smoking, salt intake, trace elements in water, constant physical activity, thyroid antibodies, the living environment in my childhood, the war experience and the recent changes in my life.

It is one thing to determine the causes of disease, and quite another – to prevent it.

Design of experiments in medium-scale on dietary prevention began in 1957 and 1960 in two psychiatric hospitals began a 12-year-old cross-experiment taking into account dietary fat. This work quickly gave the experience modifications of the standard the Finnish diet acceptable substitutes for milk and butter.

Experimental replacement of milk fat with soy oil, and butter light margarine with a high content of polyunsaturated fatty acids led to a dramatic change in the ratio P/N (polyunsaturated/saturated fatty acids) in the hospital diets: from 0.25 to 1.48 on average throughout the outdoor experiment. The level of serum cholesterol showed a significant reduction in men from an average of 267 to 226 mg/DL (up to 6.90 5.84 mmol/l), and women – from 275 to 249 mg/DL (7.11 to 6.20 mmol/l) during the study. Moreover, the incidence of coronary disease had a tendency to decrease among both men and women.

Inasmuch as the study of risk and its prevention gained momentum, society began to take this issue “closer to the heart”. In 1955 he founded the heart Association of Finland, and she became the first follower of his American predecessor, which appeared in 1924 With the start heart Association of Finland has attracted support from health authorities and various social and political leaders that eased her path of research and application of their results. Also quickly was formed and the organization for practical activities, the regional members have always been willing to update the data of the research “East-West” in North Karelia. Researchers have announced the results of Eastern Finland at the annual meetings of the society of Cardiology, which was attended by regional leaders.

In 1970, the Governor of North Karelia, ESA Timonen responded to generalizations and conclusions on the ten-year period of research gathering all the deputies of the Parliament of Finland from North Karelia and several representatives of official and voluntary organizations for the formation of influential groups. Then on 12 January 1971 signed a petition for state aid in the resolution of the problem of cardiovascular diseases in North Karelia. At the head of the delegation that delivered the petition in Helsinki, was a Governor. The petition was submitted to the Government of Finland, the National Board of health, the medical research Council of the Finnish Academy of Sciences and Heart Association Finland. The issue became public, came the promise to take action.

The first act started Heart Association Finland, having formed a special working group. This group has developed a baseline plan for the project "Northern Karelia" and the Association hired on a permanent basis two doctors to work out the details. The working group came to the conclusion that to lead such a project should not senior health workers, who are already busy with other matters, but rather the more young and strong candidate. In 1972, a leading researcher has been appointed Dr. Pekka Start-up. Doctor Start completely plunged into work the project "Northern Karelia" since its inception, worked hard throughout, and he is credited with achieving high success.

Also noteworthy two companies. "Shelter" research "East-West" in Finland was Helsinki Institute of occupational health, founded in 1951, is an establishment which offered innovative approaches and a wide range of research and services. Soon, the Institute has established close contact with the world Health Organization (who). Cardiovascular disease included in the who programme since the 1960s, first through the Regional office in Europe in Copenhagen, and then in the headquarters of the who in Geneva. There was a General interest in preventive cardiology, and between the responsible who staff have developed a close professional and personal contacts: initially — Mikhail Akhmeteli, then Zbynek Pisa to Copenhagen and Zdenek Fejfar in Geneva.

For who, the concept of the project "Northern Karelia" was a logical step towards the realization of common ideas and a good opportunity for practical testing of preventive work in society. To finalize the detailed plan for the who has deployed four international experts – Z. s-18 spotlight, who, Geneva; D. N. Morris, London; Z. Pisa, who, Copenhagen; H. Blackburn, Minneapolis – kick-off seminar held in Joensuu on September 7-9, 1971

Previously initiated the project "East-West" continued observational studies in Ilomantsi, while a new project "North Karelia" became a large-scale, multifaceted, covering the whole province of North Karelia. A control group of men from Ilomantsi compared with the representatives of completely different areas of the South-West, and the project "Northern Karelia" as the original control site was selected neighboring province of Kuopio.

In General, the project "Northern Karelia" was logical, but brave step forward, which became the basis for the results and outcomes of the research "East-West".

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