31 Aug 2012
Cholesterol levels in Finland have taken an upward swing in the last five years in all five research areas around Finland, following an uninterrupted decline between 1982 and 2007. The first results of the National FINRISK Study survey conducted in early spring of 2012 are published today in the Finnish Medical Journal (Suomen Lääkärilehti).
The study shows that between 2007 and 2012 the average total cholesterol level among Finnish men rose from 5.25 millimoles per liter (mmol/L) to 5.34 and among women from 5.15 mmol/L to 5.31. The increase was 1.7 per cent for men and 3.1 per cent for women, which is a statistically significant change. According to guidelines, total cholesterol levels should be below 5 mmol/L.
In Finland, cardiovascular mortality has decreased significantly since the 1970s especially among people of working age, and, in recent years, also among older age groups. The study shows that the most important factors contributing to the drop in cardiovascular mortality include lower cholesterol levels, lower blood pressure and reduced smoking. The most significant single factor is the lower population cholesterol levels: lower cholesterol accounts for around 80 per cent of the decrease in mortality. Both cardiovascular mortality and cholesterol levels have decreased in Finland. Cholesterol levels were at their highest in the early 1970s when the mean was around 7 mmol/L.
According to international research summaries, a one per cent change in population cholesterol levels increases coronary mortality by 2–3 per cent. In Finland, 5394 men and 1805 women under the age of 75 had a first heart attack resulting in hospitalisation in 2010. It is estimated that the incidence of heart attack will increase in the near future by around 200–300 cases for men and by 100–170 for women. To some extent, changes in other risk factors also influence trends in cardiovascular morbidity.
A shift towards healthier diets was the most significant factor contributing to the decrease in cholesterol levels seen between the 1970s and 2007. The key was a change in the quality of dietary fats: the use of hard fat (saturated fatty acids) declined and vegetable oils (polyunsaturated fatty acids) became more popular. Also, the increasing consumption of vegetables, berries and fruit has had an impact.
The recent dietary debate around low-carbohydrate diets has been confusing to some. It has also had an elevating effect on the level of cholesterol in diets. A low-carbohydrate diet can help people to lose weight, although the same effect can be gained by eating less of other foodstuffs. In Finland, however, there has been a tendency to replace starchy foods with high-fat foods, which may be bad for the heart. International studies, on the other hand, have always emphasised the importance of healthy fats in low-carbohydrate diets and that carbohydrates should be replaced with vegetable oils.
Also, it has been claimed even outside the low-carbohydrate debate that higher cholesterol levels due to the intake of hard fats do not increase the risk of cardiovascular diseases. The science community is, nonetheless, fairly unanimous in that “bad” cholesterol clogs blood vessels and that hard fats raise cholesterol levels. For example, recent national guidelines on the prevention of cardiovascular diseases in the USA recommend that the proportion of saturated fatty acids should be reduced from the currently recommended 10 per cent to no more than 7 per cent of dietary intake.
Significant factors contributing to the rising levels of cholesterol in Finland are the widespread use of butter-based fat spreads as well as consumer ignorance of their nutritional effects: most butter-based fat spreads contain a lot of saturated fatty acids that raise cholesterol, while polyunsaturated fatty acids reduce cholesterol.
The National FINRISK Study has been carried out at five-year intervals since 1972. It is based on random samples from the regions of North Karelia, North Savo, North Ostrobothnia and Kainuu, the cities of Helsinki, Vantaa, Turku and Loimaa as well as five municipalities in the region of Southwest Finland.
MD, PhD, Professor, Assistant Director General
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MD, PhD, MPolSc, Director General
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Updated 31 Aug 2012