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V Salomaa

Publications and source records attributed to V Salomaa.

At least 55 records · Page 3Linked to original sources
PubMed1998

DNA sequence diversity in a 9.7-kb region of the human lipoprotein lipase gene.

Lipoprotein lipase plays a central role in lipid metabolism and the gene that encodes this enzyme (LPL) is a candidate susceptibility gene for cardiovascular disease. Here we report the complete sequence of a fraction of the LPL gene for 71 individuals (142 chromosomes) from three populations that may have different histories affecting the organization of the sequence variation. Eighty-eight sites in this 9.7 kb vary among individuals from these three populations. Of these, 79 were single nucleotide substitutions and 9 sites involved insertion-deletion variations. The average nucleotide diversity across the region was 0.2% (or on average 1 variable site every 500 bp). At 34 of these sites, the variation was found in only one of the populations, reflecting the differing population and mutational histories. If LPL is a typical human gene, the pattern of sequence variation that exists in introns as well as exons, even for the small number of samples considered here, will present challenges for the identification of sites, or combinations of sites, that influence variation in risk of disease in the population at large.

Base Sequence↗
PubMed1998

Haplotype structure and population genetic inferences from nucleotide-sequence variation in human lipoprotein lipase.

Allelic variation in 9.7 kb of genomic DNA sequence from the human lipoprotein lipase gene (LPL) was scored in 71 healthy individuals (142 chromosomes) from three populations: African Americans (24) from Jackson, MS; Finns (24) from North Karelia, Finland; and non-Hispanic Whites (23) from Rochester, MN. The sequences had a total of 88 variable sites, with a nucleotide diversity (site-specific heterozygosity) of .002+/-.001 across this 9.7-kb region. The frequency spectrum of nucleotide variation exhibited a slight excess of heterozygosity, but, in general, the data fit expectations of the infinite-sites model of mutation and genetic drift. Allele-specific PCR helped resolve linkage phases, and a total of 88 distinct haplotypes were identified. For 1,410 (64%) of the 2,211 site pairs, all four possible gametes were present in these haplotypes, reflecting a rich history of past recombination. Despite the strong evidence for recombination, extensive linkage disequilibrium was observed. The number of haplotypes generally is much greater than the number expected under the infinite-sites model, but there was sufficient multisite linkage disequilibrium to reveal two major clades, which appear to be very old. Variation in this region of LPL may depart from the variation expected under a simple, neutral model, owing to complex historical patterns of population founding, drift, selection, and recombination. These data suggest that the design and interpretation of disease-association studies may not be as straightforward as often is assumed.

Animals↗
PubMed1998

Array-based multiplex analysis of candidate genes reveals two independent and additive genetic risk factors for myocardial infarction in the Finnish population.

We analysed common variants of eight genes implicated previously as risk factors for coronary heart disease or myocardial infarction (MI) in a cross-sectional study on patients with a history of MI and in carefully matched controls from the Finnish population. The most common low density lipoprotein receptor mutations in Finland were also included in our analysis. Multiplex genotyping of the target genes was performed using a specific and efficient array-based minisequencing system. The 4G allele of the plasminogen activator inhibitor gene (P < 0.05) and the PlA2 allele of the glycoprotein IIIa gene (P < 0.01) were associated with an increased risk of MI in our study population. We analysed the combined effect of these risk alleles and found that the concurrent carrier status of the two genetic variants conferred a high risk for the development of MI in our sample (OR = 4.5, P = 0.001), which was particularly prominent in male subjects (OR = 6.4, P = 0.0005). This study demonstrates the application of a new powerful tool for genome analysis to yield information on the inherited determinants of susceptibility to MI. The observation of two separate genes contributing an additive risk of developing MI exemplifies the advantages of multiplex analysis of genetic variation.

Adult↗
PubMed1998

Do changes in cardiovascular risk factors explain the increasing socioeconomic difference in mortality from ischaemic heart disease in Finland?

STUDY OBJECTIVE: To estimate the extent to which changes in blood pressure, smoking, and serum cholesterol concentration explain the observed increase in socioeconomic differences in mortality from ischaemic heart disease (IHD) in Finland during the past 20 years. DESIGN: Predicted changes in mortality from IHD were calculated using logistic regression models with the risk factor levels assessed by cross sectional population surveys conducted in 1972, 1977, 1982, and 1987. The subjects included white collar and blue collar workers and farmers. The predicted changes were compared with the observed mortality changes in the same socioeconomic groups in the total population of the same geographical area. SETTING: North Karelia and Kuopio provinces, eastern Finland. PARTICIPANTS: 16,741 men and 16,389 women aged 30-59 randomly drawn from the population registers of the study areas. Mortality data were obtained from the total population in the same areas. MAIN RESULTS: In men, the changes in diastolic blood pressure, total serum cholesterol, and smoking predicted a 28% decline in the mortality from IHD among white collar workers, a 30% decline among blue collar workers, and a 33% decline in farmers. Observed declines in the same socioeconomic groups were 61%, 40%, and 37%, respectively. In women, the predicted decline was 41% among white collar workers, 35% among blue collar workers, and 39% among farmers. The respective observed declines were 57%, 43%, and 20%. CONCLUSIONS: Less than half of the decline in IHD mortality among white collar men was explained by the risk factor changes, while they explained 75% of the decline among blue collar men and 89% of the decline among male farmers. Changes in risk factors did not explain the increasing difference in IHD mortality between the socioeconomic groups, especially among men.

Adult↗
PubMed1998

Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA Myocardial Infarction Register Study Group.

OBJECTIVE: To study diabetic and nondiabetic patients with their first myocardial infarction to determine overall 1-year mortality, out-of-hospital mortality, 28-day mortality of hospitalized patients, and 1-year mortality of 28-day survivors. RESEARCH DESIGN AND METHODS: This study--based on the FINMONICA Myocardial Infarction Register, a part of the Finnish contribution to the WHO MONICA Project (World Health Organization Multinational Monitoring of Trends and Determinants of Cardiovascular Disease)--covered coronary heart disease (CHD) deaths and acute CHD events occurring during hospitalization among residents of Finland aged 25-64 years in three geographically defined areas. The study population comprised 620 diabetic and 3,445 nondiabetic patients who had their first myocardial infarction during the years 1988-1992. RESULTS: The age- and area-adjusted mortality rates and hazard ratios (HRs) for diabetic versus nondiabetic patients (95% CI) were as follows: The 1-year mortality rate was 44.2% in diabetic men and 32.6% in nondiabetic men (HR, 1.38; 1.18-1.61) and 36.9% in diabetic women and 20.2% in nondiabetic women (HR, 1.86; 1.40-2.46); the out-of-hospital mortality rate was 28.3% in diabetic men and 22.4% in nondiabetic men (HR, 1.25; 1.03-1.52) and 10.4% in diabetic women and 11.0% in nondiabetic women (HR, 0.95; 0.58-1.54); the 28-day mortality rate of hospitalized patients was 14.4% in diabetic men and 8.8% in nondiabetic men (HR, 1.58; 1.15-2.18) and 21.7% in diabetic women and 7.8% in nondiabetic women (HR, 2.60; 1.71-3.95); and the 1-year mortality rate of 28-day survivors was 9.6% in diabetic men and 5.0% in nondiabetic men (HR, 1.97; 1.25-3.12) and 10.7% in diabetic women and 2.5% in nondiabetic women (HR, 4.17; 2.05-8.51). CONCLUSIONS: The high mortality rate of diabetic patients after their first myocardial infarction and the high proportion of out-of-hospital deaths in this group imply that vigorous primary and secondary preventive measures should become an integral part of their medical care.

Adult↗
PubMed1998

Intra- and interindividual variability of hemostatic factors and traditional cardiovascular risk factors in a three-year follow-up.

Elucidation of the key role of thrombosis in cardiovascular disease events has arisen considerable interest in hemostatic factors and in the repeatability of their determinations. Data on long-term repeatability has, however, remained scanty. We examined twice 208 men and 265 women in North Karelia, eastern Finland. The baseline examination was a part of the FINRISK 1992 Hemostasis Study and the age-range of participants was between 45-64 years. The re-examination took place three years later in 1995. Both surveys followed the same protocol and were carried out during the same season. Spearman rank correlation coefficients between 1992 and 1995 measurements of fibrinogen, factor VII coagulant activity (FVII:C), factor VII antigen (FVII:Ag), and plasminogen were among men 0.72, 0.77, 0.46 and 0.56, respectively. For total cholesterol, HDL-cholesterol, triglycerides and diastolic blood pressure the corresponding coefficients were 0.74, 0.83, 0.66, and 0.54. In women, the coefficient of fibrinogen was lower than in men, 0.62, otherwise the results were similar. Of men belonging to the highest quarter of fibrinogen, FVII:C, FVII:Ag and plasminogen in 1992, 65%, 60%, 53% and 60% belonged to the highest quarter of respective distributions also in 1995. In women, the corresponding proportions were 64%, 65%, 46% and 58%. The modest repeatability of FVII:Ag and plasminogen was mainly due to the high intraindividual variability. However, in comparisons of plasma levels between two groups, relatively small sample sizes seemed to give adequate statistical power to detect possible differences in FVII:Ag and plasminogen. In conclusion, the long-term repeatability of fibrinogen and FVII:C is similar to that of triglycerides and even better than that of diastolic blood pressure, but somewhat lower than the repeatability of total cholesterol. FVII:Ag and plasminogen did not have very good repeatability and more than one measurement of them should be considered if they are used as predictors of cardiovascular disease in prospective studies.

Cardiovascular Diseases↗
PubMed1998

Changes in premature deaths in Finland: successful long-term prevention of cardiovascular diseases.

This article describes the long-term consequences of successful cardiovascular disease (CVD) prevention and its influence on premature mortality in Finland, with special reference to North Karelia. Active community-based CVD prevention began in 1972 in the province of North Karelia (population, 180,000). Since 1977, active preventive work has been carried out nationwide, taking advantage of the experience from North Karelia, which continued as a demonstration area for integrated prevention of noncommunicable diseases. Comprehensive community-based interventions as part of WHO interhealth and CINDI programmes in North Karelia and nationwide aimed at changing the target risk factors and health behaviours (serum cholesterol, blood pressure, smoking, diet) at the population level. Age-adjusted mortality rates for CVD, coronary heart disease (CHD), cerebrovascular disease, all cancers, lung cancer, accidents and violence, and all causes in the population aged 35-64 years from the pre-programme period (1969-71) to 1995 were the main measures of the outcome. Among men there was a great reduction in deaths from CHD, CVD, cancer, and all causes in the whole country. From 1969-71 to 1995 the age-standardized CHD mortality (per 100,000) decreased in North Karelia by 73% (from 672 to 185) and nationwide by 65% (from 465 to 165). The reduction in CVD mortality was of the same magnitude. Among men, CHD mortality decreased in the 1970s, as did lung cancer mortality in the 1980s and 1990s, significantly more in North Karelia than in all of Finland. Among women there was a great reduction in CVD (including CHD and stroke) mortality and all-causes mortality, but only a small reduction in cancer mortality. These results show that a major reduction in CVD mortality among the working-age population can take place in association with active reduction of major risk factors, with a favourable impact on cancer and all-causes mortality.

Adult↗
PubMed1997

Mild myocardial infarction--a classification problem in epidemiologic studies. WHO MONICA Project.

In studies assessing the trends in coronary events, such as the World Health Organization (WHO) MONICA Project (multinational MONItoring of trends and determinants of CArdiovascular disease), the main emphasis has been on coronary deaths and non-fatal definite myocardial infarctions (MI). It is, however, possible that the proportion of milder MIs may be increasing because of improvements in treatment and reductions in levels of risk factors. We used the MI register data of the WHO MONICA Project to investigate several definitions for mild non-fatal MIs that would be applicable in various settings and could be used to assess trends in milder coronary events. Of 38 populations participating in the WHO MONICA MI register study, more than half registered a sufficiently wide spectrum of events that it was possible to identify subsets of milder cases. The event rates and case-fatality rates of MI are clearly dependent on the spectrum of non-fatal MIs, which are included. On clinical grounds we propose that the original MONICA category "non-fatal possible MI" could be divided into two groups: "non-fatal probable MI" and "prolonged chest pain." Non-fatal probable MIs are cases, which in addition to "typical symptoms" have electrocardiogram (ECG) or enzyme changes suggesting cardiac ischemia, but not severe enough to fulfil the criteria for non-fatal definite MI. In more than half of the MONICA Collaborating Centers, the registration of MI covers these milder events reasonably well. Proportions of non-fatal probable MIs vary less between populations than do proportions of non-fatal possible MIs. Also rates of non-fatal probable MI are somewhat more highly correlated with rates of fatal events and non-fatal definite MI. These findings support the validity of the category of non-fatal probable MI. In each center the increase in event rates and the decrease in case-fatality due to the inclusion of non-fatal probable MI was larger for women than men. For the WHO MONICA Project and other epidemiological studies the proposed category of non-fatal probable MIs can be used for assessing trends in rates of milder MI.

Adult↗
PubMed1997

The validity of hospital discharge register data on coronary heart disease in Finland.

We studied the validity of the Finnish hospital discharge register data on coronary heart disease (CHD) for the purposes of epidemiologic studies and health services research. The Finnish nationwide hospital discharge register (HDR) was linked with the FINMONICA acute myocardial infarction (AMI) register for the years 1983-1990. The frequency of errors in the HDR was assessed separately. Between 8% and 13% of hospitalized AMI events registered in the AMI Register were not found in the HDR with an ICD code for CHD. Problems with the register linkage and the use of some ICD code other than one of the codes for CHD explained these missing events. The frequency of errors in the personal identification number was about 5% in the early 1980s. After 1986 errors were found only occasionally. The diagnosis recorded in the HDR was the same as that in the discharge sheet in about 95% of hospitalizations. The positive predictive value of the ICD code 410 (AMI), compared with the FINMONICA definite+possible AMI category, was very high and stable, about 90% in all areas and all hospitals, but the sensitivity varied from 50% at local hospitals to 80% at central hospitals. In summary, data on CHD obtained from the Finnish hospital discharge register give, on average, a correct picture on changes in the occurrence of AMI in Finland and can, with necessary caution, be used in epidemiological studies and health services research. However, the classification of individual cases is not standardized in the HDR, but varies over time, between geographical areas and the levels of care. Therefore, these data should not be used without confirmation in studies where correct classification of individual outcomes is of crucial importance, such as follow-up studies and case-control studies.

Adult↗
PubMed1997

Atrial fibrillation in older stroke patients: association with recurrence and mortality after first ischemic stroke.

OBJECTIVES: The objective of this study was to determine the association of atrial fibrillation (AF) with stroke recurrence and mortality and with the causes of death in ischemic stroke patients aged 75 years and older. DESIGN: A population-based study. SETTING: The cities of Turku and Kuopio in Finland. PARTICIPANTS: The study cohort consisted of 2635 consecutive patients aged 75 years and older, with a first ischemic stroke, registered in the FINMONICA Stroke Register. MEASUREMENTS: 28-day and 1-year stroke mortality, causes of death, and recurrence of stroke. RESULTS: There were 767 stroke patients with AF (mean age 82.2) and 1868 patients without AF (mean age 81.4). Mortality was higher in the AF group both 28 days (33.9% vs 28.1%, P = .003) and 1 year after the attack (52.7% vs 43.0%, P < .001). The age- and sex-adjusted relative risk of death at 28 days was 1.25 in the AF group (95% confidence interval (CI) 1.04-1.50, P = .018), and at 1 year it was 1.41 (95% CI 1.18-1.67, P < .001). In a Cox proportional hazards model, 1-year mortality risk comparing the AF-group with non-AF group was 1.24 (95% CI 1.10-1.39, P < .001). The strongest risk factor predicting 1-year mortality was recent myocardial infarction (MI) (RR 1.90, 95% CI 1.49-2.42). Myocardial infarction was more often the underlying cause of death in the AF group during the period of 28 days, but not from 28 days up to 1 year. The 1-year recurrence rate among those alive at day 28 was 11.5% in the AF group and 9.4% in the non-AF group (P = .240). CONCLUSION: Recent MI and AF are independent negative prognostic factors in older patients with stroke. Although the relative risk estimates attributable to AF are of the same magnitude in older as in middle-aged stroke patients, the much higher prevalence of AF in the older patients emphasizes its absolute impact on the mortality and recurrence after the first ischemic stroke in the age group 75 years and older. The treatment of coexisting cardiac disease also has the potential to prevent deaths and recurrent stroke events in older persons.

Aged↗
PubMed1997

Trends in case-fatality of stroke in Finland during 1983 to 1992.

BACKGROUND AND PURPOSE: Stroke mortality has been declining in Finland during the past 20 years. It is not known, however, whether this favorable development is attributable to the decline in the incidence or case-fatality of stroke. For this reason we examined the trends in case-fatality of stroke, including trends by subtype of stroke. METHODS: The analyses were carried out using data of the community-based FINMONICA Stroke Register, which was operating in three geographic areas of Finland during 1983 to 1992. All stroke events (n = 11,171) in persons aged 35 to 74 years were included in this register. RESULTS: The 28-day case-fatality of stroke fell yearly by 3.6% (P = .01) in men and by 2.6% (P = .2) in women. At the end of the study period, the average 28-day case-fatality of all strokes was 20% in men and 21% in women. Considerable differences by subtype of stroke were observed. The 28-day case-fatalities at the end of the study period were in men-56% for subarachnoid hemorrhage, 42% for intracerebral hemorrhage, and 14% for cerebral infarction. In women, the corresponding figures were 49%, 49%, and 14%. The 28-day case-fatality of subarachnoid hemorrhage did not change during the study period, but for intracerebral hemorrhage, a significant decline was observed in men and there was a declining trend also in women. The 28-day case-fatality of cerebral infarction declined significantly in both genders. CONCLUSIONS: With the exception of subarachnoid hemorrhage, the 28-day case-fatality of stroke has fallen in Finland. It is likely that this fall has contributed to the decline in stroke mortality.

Adult↗
PubMed1997

Atrial fibrillation and stroke. Mortality and causes of death after the first acute ischemic stroke.

BACKGROUND AND PURPOSE: Atrial fibrillation (AF) is a risk factor for stroke. This study was undertaken to determine the influence of AF on the mortality of stroke patients and on the causes of death after a stroke event. METHODS: Patients with first ischemic stroke who were .35 to 74 years old and registered in the FINMONICA stroke register during 1982 through 1992 were analyzed (n = 6912). There were 642 patients with AF (9.3%) (mean age, 67 years) and 6270 patients without AF (90.3%) (mean age, 63 years). The association between AF and stroke mortality was investigated by use of logistic regression and Cox proportional hazards models. RESULTS: Mortality was higher in the AF group both at 28 days (19.5% versus 14.4%, P < .001) and 1 year after the attack (30.5% versus 21.8%, P < .001). After adjustment for age and sex, the odds ratio for 28-day case fatality (AF versus non-AF) was 1.27 (95% CI, 1.03 to 1.56; P = .003), and that for 1-year mortality was 1.36 (95% CI, 1.14 to 1.63; P < .001). In the proportional hazards model, AF was a significant independent risk factor for 1-year mortality (hazard ratio, 1.26; 95% CI, 1.09 to 1.46; P = .002). Cardiac causes of death were more common in the AF group at the acute stage. In the course of 1 year, there were no differences in the distributions of causes of death. CONCLUSIONS: Stroke patients with AF are at high risk of death both at the acute phase of stroke and during the subsequent year after the first acute stroke event. Mortality from cardiac diseases prevailed in the AF group during the acute phase of stroke. Careful cardiac evaluation and treatment are essential in patients with AF and stroke.

Acute Disease↗
PubMed1996

Decline of coronary heart disease mortality in Finland during 1983 to 1992: roles of incidence, recurrence, and case-fatality. The FINMONICA MI Register Study.

BACKGROUND: The rate of coronary heart disease (CHD) mortality in eastern Finland has been the highest in the world. The official mortality statistics suggest, however, that is has declined by 60% during the past 20 years. The aim of the present study was to examine the contributions of incidence, recurrence, and case fatality of coronary events to the trends in CHD mortality in three areas of Finland. METHODS AND RESULTS: Population-based myocardial infarction registers have been operating in the provinces of North Karelia and Kuopio in eastern Finland and the Turku/Loimaa area in southwestern Finland from 1983 to 1992. During this 10-year period, each suspected coronary event in persons 35 to 64 years of age was evaluated for registration. Of these, 13,566 fulfilled the criteria of myocardial infarction or coronary death. Almost one fourth (22.4%) of the coronary events were sudden, out-of-hospital deaths. Among men, the average change in mortality was -7.1% per year (95% confidence interval, -8.4% to -5.8%) in North Karelia, -5.0% per 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 due to a decline in recurrent coronary events but also in the incidence of first coronary events, whereas in southwestern Finland, the decline in case-fatality rate had the major role. CONCLUSIONS: The decline in CHD mortality rate in Finland appears to be the result of a successful combination of primary and secondary prevention measures and improvements in acute coronary care.

Adult↗
PubMed1996

Acute myocardial infarction in Estonia: first results from the Tallinn AMI Register.

The acute myocardial infarction (AMI) register of Tallinn, the capital of Estonia, started in 1990. The register follows methodology recommended by the WHO MONICA Project for the registration of coronary events. By standardizing its procedures with the FINMONICA AMI register, the Tallinn AMI register aims at producing data comparable with those of the centers participating in the WHO MONICA Project. This article presents incidence, attack rates, and mortality rates of AMI in Estonia during the first year of registration in Estonians and non-Estonians (mostly Russians) of the study area. The total number of registered AMI events was 493 among men and 117 among women. The age-standardized mortality from AMI (per 100,000 population) was 249 (95% confidence interval, 201-297) in Estonian men and 234 (189-279) in non-Estonian men. In women the corresponding rates were 35 (20-50) and 39 (23-55), respectively. The incidence and attack rate of AMI were not different in Estonians and non-Estonians. The incidence of AMI seems to be relatively high in international comparison. The registration period of our study is thus far rather short, but it is the first investigation of the incidence of AMI in Estonia based on standardized data collection procedures. This study provides a basis for the development of surveillance of cardiovascular disease in Estonia.

Adult↗
PubMed1996

Seasonal variation in the occurrence of stroke in a Finnish adult population. The FINMONICA Stroke Register. Finnish Monitoring Trends and Determinants in Cardiovascular Disease.

BACKGROUND AND PURPOSE: Seasonal influence on the incidence of and mortality from cerebrovascular disease has been reported during the last three decades, but generally with some discrepancy in results, particularly regarding stroke subtypes. The aim of this study was to examine seasonal variation in the incidence, mortality, and case-fatality rate of stroke in data from the FINMONICA population-based stroke register. METHODS: During 1982 to 1992, 15449 stroke events were registered in the monitored populations aged 25 to 99 years in three geographic areas of Finland: the provinces of Kuopio and North Karelia in eastern Finland and the Turku/Loimaa area in southwestern Finland. We analyzed the seasonal and monthly incidence, mortality, and case-fatality rate of stroke and subtypes of stroke by pooling the data for the three areas and stratifying by sex and age. RESULTS: The rate of occurrence of ischemic stroke events was 12% (95% confidence interval [CI], 5% to 20%) greater in men and 11% (95% CI, 4% to 19%) greater in women in winter than in summer. For intracerebral hemorrhage, we observed a 28% (95% CI, 3% to 58%) greater rate of occurrence in men and a 33% (95% CI, 6% to 66%) greater rate of occurrence in women in winter than in summer. The occurrence of subarachnoid hemorrhage did not vary significantly by season. The greater incidence of ischemic strokes in winter was particularly prominent among men aged 25 to 64 years and less prominent in elderly men and in women. The 28-day case-fatality rate of ischemic stroke showed significant seasonal variation only in women (P = .001), with the lowest rate in summer. CONCLUSIONS: There is a significantly greater incidence of ischemic strokes and intracerebral hemorrhages during winter in Finland. Further research that also takes meteorologic and sociodemographic factors into account is warranted, since it may help to determine new ways to prevent strokes.

Adult↗
PubMed1996

Ten-year trends in stroke incidence and mortality in the FINMONICA Stroke Study.

BACKGROUND AND PURPOSE: The trends in stroke incidence reported so far have not been entirely consistent, although declining trends in mortality from stroke have been reported from a number of studies around the world. This study aims to evaluate the 10-year trends (from 1983 through 1992) in incidence, attack rate, and mortality of stroke in the Finnish population. METHODS: A population-based stroke register was set up in the early 1980s to collect data on all suspected events of acute stroke that occurred in the population aged 25 to 74 years permanently residing in three geographic areas of Finland: the provinces of Kuopio and North Karelia in eastern Finland and the Turku-Loimaa area in southwestern Finland. Trends in age-standardized attack rates, incidence, and mortality were calculated for the period studied. RESULTS: During the 10-year study period, 11 392 acute stroke events occurred in the monitored populations. A statistically significant decline was observed in the pooled FINMONICA data, both in the incidence of stroke (-1.7% with 95% confidence interval [CI], -3.0% to -0.5% per year in men; -2.2% with 95% CI, -3.6% to -0.7% per year in women) and in mortality from stroke (-5.2% with 95% CI, -8.2% to -2.2% per year; -4.7% with 95% CI, -8.2% to -1.2% per year). The attack rate of stroke also declined significantly in both sexes. When the areas were considered separately, the declining trends were observed within each area. The decline in incidence of stroke was, however, statistically significant only among men and women in Kuopio and among women in Turku/Loimaa. Mortality declined significantly in all three areas among men but among women only in Kuopio. The incidence to mortality rate ratio increased during the study period, indicating a steeper fall in mortality than in incidence. CONCLUSIONS: A substantial decline in both stroke incidence and mortality was observed in the adult and elderly population in the FINMONICA study areas. Part but not all of the decline in stroke mortality, observed also in the official mortality statistics, can be attributed to the decline in stroke incidence during this 10-year period.

Adult↗