| Summary: | Coronary heart disease is the main killer in the middle-aged populations of most European countries. Until recently it was argued whether it is preventable or not. Results from several preventive trials which were carried out in various countries and which used different study designs have now removed this uncertainty. Without any doubts we can admit that prevention of coronary heart disease is possible and that the burden from this disease can be reduced. The first attempt to prevent coronary heart disease in the entire community was initiated in the county of North Karelia, Finland, in 1972. At that time, the occurence of coronary heart disease in North Karelia was highest in the world. The programme, the North Karelia Project has been carefully evaluated, and the data collected showed that during 10 years from the start of the Project mortality from coronary heart disease fell by 30% in men and 50% in women. Such encouraging results were obtained through intensive efforts aimed at reducing the levels of the known risk factors of coronary heart disease. The North Karelia Project showed that risk factors like serum cholesterol, blood pressure and cigarette smoking were significantly reduced, leading then to reduced disease rates. The intervention of the North Karelia Project included more than a medical approach only. All possible sectors of the community were invited to contribute to the Project. The general principle was: 'The mass health problem can only be solved through a mass approach". This meant active participation of the whole population, extensive and systematic health education, training of health personnel and other community groups, environmental changes to control smoking and to manufacture and promote healthier food products, etc. Finally, I have to stress that all that work was done in the area which has the lowest socioeconomic standards in Finland. The message from the North Karelia Project is that prevention of coronary heart disease should become a part of health care in countries which suffer from the modern epidemic of heart diseases. Malta is one of such countries. Even though the incidence of coronary heart disease has never reached such extreme levels as experienced for instance in Finland, circulatory diseases are the most important cause of death in Malta. Out of about 3000 deaths in Malta 1900 were due to these diseases. Moreover, the life expectancy of Maltese men has not at all increased during the last 25 years and that of Maltese women during the last 15 years. This static situation is mainly due to the high number of deaths from circulatory diseases. One important step in starting preventive measures is to prepare concrete guidelines for the activities needed. This booklet provides such initiative for the Maltese population. To implement these recommendations is the next step. That will be not an easy task but once started there is no doubt that many premature deaths will be saved in Malta, too. [Preface by Jaakko Tuomilehto] N/A
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