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Twenty-Year Dynamics of Serum Cholesterol Levels in the Middle-Aged Population of Eastern Finland

Pekka Jousilahti, MD, MSc; Erkki Vartiainen, MD, PhD; Jaakko Tuomilehto, MD, PhD, MPolSc; and Pekka Puska, MD, PhD, MPolSc
[+] Article and Author Information

From the National Public Health Institute, Helsinki, Finland. Requests for Reprints: Pekka Jousilahti, MD, Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. Current Author Addresses: Drs. Jousilahti, Vartiainen, Tuomilehto, and Puska: Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;125(9):713-722. doi:10.7326/0003-4819-125-9-199611010-00002
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Background: In cross-sectional analyses, serum cholesterol levels differ among different age groups. However, secular time trends in cholesterol levels can be seen across age groups in a population. A birth cohort analysis provides useful information on the combined effect of age and time on changes in serum cholesterol levels.

Objective: To analyze the 20-year dynamics of serum total cholesterol levels in relation to age, sex, birth cohort, time period, mortality rate, and changes in the intake of saturated fats.

Design: Cross-sectional measurements of serum total cholesterol levels in five independent population surveys done in 1972, 1977, 1982, 1987, and 1992.

Setting: Kuopio and North Karelia provinces in eastern Finland.

Patients: Random sample of 16 711 men and 17 542 women 25 to 64 years of age. Persons in the oldest birth cohort were born in 1913; persons in the youngest birth cohort were born in 1967.

Measurements: Total serum cholesterol levels and daily intake of dietary fat.

Results: Between 1972 and 1992, mean cholesterol levels decreased with time in each age group and for both sexes. According to the cross-sectional data, cholesterol levels increased with age and increased more steeply in women than in men. Contrary to these data, cholesterol levels in birth cohorts did not increase with age. Cholesterol levels did not change at all within birth cohorts of women and started to decrease after 45 years of age in birth cohorts of men. Cholesterol levels in the youngest birth cohorts (persons 25 to 29 years of age) entering the study each study year were markedly lower than levels in the same age group in the previous survey of risk factors. Daily intake of saturated fat decreased markedly between 1972 and 1992. Most of this decrease could be explained by change in intake of liquid dairy products and spreadable fats. In both sexes, changes in saturated fat intake were correlated with the time period, whereas the association with age was weak.

Conclusions: In this Finnish population, total serum cholesterol levels are more closely associated with birth cohort than with age. Changes in dietary intake of saturated fat over time may account for changes in cholesterol levels. This finding suggests that community-based strategies for preventing cardiovascular disease can affect most of the population.

Figures

Grahic Jump Location
Figure 1. The following are the variable estimates of the linear regression analysis. Model 1 (sex, age, study year, interaction between sex and study year): sex, −0.13( < 0.001); age, 0.22 ( < 0.001); study year, −0.25( < 0.001); interaction between sex and study year, < 0.001. Model 2 (age, study year, interaction between age and study year): in men: age, 0.15 ( < 0.001); study year, −0.22( < 0.001); interaction between age and study year, = 0.08; in women: age, 0.28 ( < 0.001); study year, −0.28( < 0.001); interaction between age and study year, > 0.2.
Serum cholesterol levels in men and women according to age group and study year.PPPPPPPPPP
Grahic Jump Location
Grahic Jump Location
Figure 2. The following are the variable estimates of the linear regression analysis. Model 1 (sex, age, study year, interaction between sex and age): sex, −0.13( < 0.001); age, 0.22 ( < 0.01); study year, −0.25( < 0.001); interaction between sex and age, < 0.001. Model 2 (age, study year, interaction between age groups): in men: age, 0.15 ( < 0.001); study year, −0.22( < 0.001); interaction between age groups, < 0.001; in women: age, 0.28 ( < 0.001); study year, −0.28( < 0.001); interaction between ages, < 0.001. Model 3 (age, study year): in men by age group—25 to 44 years of age: age, 0.26 ( < 0.001); study year, −0.22( < 0.001); 45 to 64 years of age: age, −0.01( > 0.2); study year, −0.21( < 0.001); in women by age group—25 to 44 years of age: age, 0.19 ( < 0.001); study year, −0.26( < 0.001); 45 to 64 years of age: age, 0.29 ( < 0.001); study year, −0.29( < 0.001).
Serum cholesterol levels in men and women according to age group and study year.PPPPPPPPPPPPPPPPPP
Grahic Jump Location
Grahic Jump Location
Figure 3. The following are the variable estimates of the linear regression analysis. Model 1 (sex, age, birth cohort, interaction between sex and birth cohort): sex, −0.13( < 0.001); age, −0.04( < 0.001); birth cohort, −0.25( < 0.001); interaction between sex and birth cohort, < 0.001. Model 2 (age, birth cohort, interaction between age and birth cohort): in men: age, −0.08( < 0.001); birth cohort, −0.22( < 0.001); interaction between age and birth cohort, < 0.001; in women: age, 0.00 ( > 0.2); birth cohort, −0.28( < 0.001); interaction between age and birth cohort, < 0.001. Model 3 (age): in men by birth cohorts: 1913 to 1917, −0.24( < 0.01); 1918 to 1922, −0.29( < 0.001); 1923 to 1927, −0.20( < 0.001); 1928 to 1932, −0.13( < 0.001); 1933 to 1937, −0.10( < 0.001); 1938 to 1942, −0.03( > 0.2); 1943 to 1947, 0.04 ( < 0.05); 1948 to 1952, 0.11 ( < 0.001); 1953 to 1957, 0.13 ( < 0.01); 1958 to 1962, 0.02 ( > 0.2); in women by birth cohorts: 1913 to 1917, −0.16( < 0.05); 1918 to 1922, −0.10( < 0.01); 1923 to 1927, 0.06 ( < 0.05); 1928 to 1932, 0.03 ( = 0.11); 1933 to 1937, 0.03 ( = 0.11); 1938 to 1942, −0.02( > 0.2); 1943 to 1947, −0.07( < 0.001); 1948 to 1952, −0.05( = 0.08); 1953 to 1957, 0.01 ( > 0.2); 1958 to 1962, −0.05( > 0.2).
Serum cholesterol levels in men and women according to age group and birth cohort.PPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
Grahic Jump Location

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