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BACKGROUND

The North Karelia Project was launched when mortality rates of CVD-especially of coronary heart disease (CHD), but also of cerebrovascular stroke-were exceptionally high in Finland, particularly in the eastern regions (Karvonen et al 1967, Pisa and Uemura 1982, Keys and Aravanis 1980). The main objective at the outset was to achieve a substantial de cline in this mortality, especially among middle-aged men. When the project joined the WHO/CINDI programme lat er on, there was a greater emphasis on the more integrated needs of non communicable disease (NCD) prevention. Also, over the years the emphasis shifted onto the national level.

Early publications from the North Karelia Project team reported a major decline in CHD mortality. The analyses also showed that in the 1970s this decline was significantly greater than in the reference prov ince of Kuopio (Salonen et al 1983). After the original Project period the activity has concerned all of Finland, but there has still been special attention on North Karelia.