Salonen J T, Tuomilehto J, Nissinen A, Kaplan G A, Puska P
Department of Community Health and General Practice, University of Kuopio, Finland.
Int J Epidemiol. 1989 Sep;18(3):595-601. doi: 10.1093/ije/18.3.595.
We investigated the contribution of risk factor changes to the decline in incidence of ischaemic heart disease between three five-year periods (1972-76, 1977-81, 1982-86) in a community-based cardiovascular disease (CVD) control programme, the nOrth Karelia project. Random population samples of over 10,000 people were examined in 1972, 1977 and 1982 and followed for five years. Population attributable benefits were estimated for each time period from reductions in excess risk associated with S-cholesterol, tobacco products per day and the mean of systolic and diastolic blood pressure which were entered in logistic models with age and sex. Changes in risk factors accounted in North Karelia for 89% and in the reference population for 20% of the decline in ischaemic heart disease from 1972-6 to 1977-81. In healthy people, risk factor reductions accounted in North Karelia for 100%, but in the reference population only for 23% of the decline. The decline was non-significant in both areas from 1977-81 to 1982-86. In subjects with either CVD or diabetes, there was no decline in North Karelia in either period, whereas 30% and 64% of the decline (ns) in the reference population in the two periods, respectively, was attributable to risk factor changes. These data suggest that although the decline in the incidence of ischaemic heart disease in North Karelia did not differ from that in the reference population it was largely attributable to risk factor reductions in the healthy population. The decline in the reference population appears to be associated with changes in lifestyle, secondary prevention activities and medical care.
我们在一项以社区为基础的心血管疾病（CVD）控制项目——北卡累利阿项目中，调查了三个五年期（1972 - 1976年、1977 - 1981年、1982 - 1986年）期间危险因素变化对缺血性心脏病发病率下降的贡献。1972年、1977年和1982年对超过10000人的随机人群样本进行了检查，并随访了五年。根据与血清胆固醇、每日烟草制品以及收缩压和舒张压平均值相关的超额风险降低情况，对每个时间段的人群归因益处进行了估计，这些因素被纳入了包含年龄和性别的逻辑模型中。在北卡累利阿，1972 - 1976年至1977 - 1981年期间，危险因素变化占缺血性心脏病发病率下降的89%，在对照人群中占20%。在健康人群中，北卡累利阿危险因素降低占发病率下降的100%，但在对照人群中仅占23%。1977 - 1981年至1982 - 1986年期间，两个地区的发病率下降均无统计学意义。在患有心血管疾病或糖尿病的受试者中，北卡累利阿在两个时期发病率均未下降，而对照人群在这两个时期发病率下降的30%和64%（无统计学意义）分别归因于危险因素变化。这些数据表明，尽管北卡累利阿缺血性心脏病发病率的下降与对照人群没有差异，但很大程度上归因于健康人群中危险因素的降低。对照人群发病率的下降似乎与生活方式的改变、二级预防活动和医疗护理有关。
