Epidemiology of Cariovascular Diseases & the Implementation and Evaluation of Community Programs to Modify Risk Factors

Researcher name: 
J. George Fodor, MD, PhD, FRCPC

I joined the Medical School of Memorial University of Newfoundland in 1971. At that time, Newfoundland had the highest mortality and morbidity for cerebrovascular strokes of all provinces in Canada and has also the highest mortality for coronary heart disease. It was imperative to identify the factors in this project contributing to this situation.

I joined the Medical School of Memorial University of Newfoundland in 1971. At that time, Newfoundland had the highest mortality and morbidity for cerebrovascular strokes of all provinces in Canada and has also the highest mortality for coronary heart disease. It was imperative to identify the factors in this project contributing to this situation. Pioneering work had already been done by the first Dean of the Medical School, Dr. Ian Rusted, and his co-workers, Dr. Carl Abbott and Dr. Ian Senciall. Continuing on their work, we have identified arterial hypertension as an unusually common condition in Newfoundland. Doubtlessly, this had a major effect on the frequency of cerebrovascular strokes and other forms of heart disease.

Using my previous experience to analyse similar situations in Czechoslovakia and Sweden, we carried out a number of epidemiological studies on various population samples. The environmental factors which could be responsible for the unusually high occurrence of the cardiovascular diseases had been analysed. At the end of this effort, it was possible to identify as a major contributory factor of this situation, a hypercaloric diet with high salt intake and a lack of protective elements, particularly potassium and calcium. Other environmental factors, for example, water hardness/softness, also pointed toward a possible influence of electrolytes on the high incidence and prevalence of hypertension. The presence of a number of other cardiovascular risk factors had been ascertained: lack of physical exercise, obesity, and smoking.

As a result of these findings, an intensive professional education had been launched with the results that the high-risk conditions are today detected in a much earlier stage and being intensively treated. There had been a substantial success in reducing the cerebrovascular stroke mortality and morbidity in Newfoundland. We are still concerned at present that the decline of coronary heart disease is not as large in this province as in other parts of Canada. In 1990, a major preventive study had been initiated, involving nearly 1,000 residents from three geographical areas in Newfoundland. In these residents, a detailed cardiovascular risk factor profile had been assessed and, in one of these areas, an intensive program is in progress attempting to change unhealthy lifestyle habits. The outcome of this action would be evaluated in 1993. We hope that we will be able to show a reduction of cardiovascular risk factors and to achieve a further decline in the coronary heart disease mortality and morbidity.

We could not have carried out these actions without a substantial support from the National Health Research and Development Program, which funded a number of our projects in the past. Our thanks also to the Heart and Stroke Foundation of Canada, which also contributed substantially to implementation of our exploratory surveys.