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Sequel

Many years later, at a pleasant social evening arranged at the Paavo Nurmi Symposium in Helsinki, our host, Martti Karvonen, skillfully arranged a visit of conferees with President Kekkonen in the main salon. The vigorous old man had recently lost his wife. The month before, he had presided over the Helsinki Conference on Human Rights.

Kekkonen was full of himself that evening, exhilarated over the successful signing of the Human Rights Accords, enthusiastic about the significant role a small country can play in human affairs by sticking to principles, addressing central human issues, and showing imagination and enterprise. The aging diplomat-soldier, near retirement, seemed happy to spend the evening with physicians and scientists from around the world. He was in fine story-telling fettle.

Karvonen had arranged that we guests would each move forward unostentatiously around the President's table at intervals of several minutes, so that small groups of two or three people would have nearly private conversations with the President. As my small group approached the grand figure, I had a moment of panic about what we would talk about. Then came the idea to bring up mutual experiences with Hubert Humphrey, recently dead, a friend of so many great leaders and long a friend of Finland and its people. But suddenly it dawned on me to recount the story of Saarinen, Renaissance Man in the Forest.

I introduced the tale by saying, "We may have a mutual friend in Ilomantsi. A gentleman whose name escapes me invited our research team to his home some years ago" - and then I went on to the story of that evening in Karelia. I had not yet gotten to the fishing photographs when the President laughed, slapped his knee and said, "Oh, you are talking about my dear friend, Pentti Saarinen, of course."

President Kekkonen went on to finish the story for the others; his friend's mastery of cuisine, brewing of tea, confection of liqueurs, salmon fishing with the world's great leaders, fly-tying, stamp collecting and, yes, his loving collection of classical erotica.

These presidential reflections, years after the original event, were a delightful sequel to one of my more remarkable adventures in the field!

Conclusions

Much of the excitement and anticipation of Karvonen and Keys about the contribution of the Finnish cohort was realized.

The findings in Finland have had a profound impact on cardiovascular disease epidemiology and prevention. They established the world's highest coronary heart disease rates (for the 1960s) among the East Finnish men. They illustrated the overwhelming role of a high-saturated-fatty-acid diet in mass elevation of blood cholesterol levels, the principal population cause of atherosclerosis.

The findings strongly affected thinking about population versus individual causes of coronary heart disease and led to research on why rates in East Finnish men are greater than predicted from their blood lipid levels.

The Finnish "natural experiment" has also reveal ed important contributions of anti-oxidants and minerals and perhaps iron to cardiovascular disease risk. Equally influential has been the revelation that an active outdoor lifestyle and high levels of occupational activity, within a relatively calm, stress-free environment, are not protective against high population rates of cardiovascular disease in the presence of a grossly atherogenic diet.

Finally, the Seven Countries Study in Karelia had the unexpected side-effect of motivating the population of that region to inquire into the lifestyle and modifiable origins of their severe disease burden and to mobilize community prevention efforts. The resulting North Karelia Project starting in 1972, was the first major community-based program of cardiovascular disease prevention and health promotion. The Finnish story is not yet finished!