The power of prevention: How EvidenceNOW and ESCALATES can Extend the Lives of Tens of Millions of Americans

Thomas Kottke, MD, MSPH, HealthPartners Institute of Education and Research; Co-investigator, ESCALATES


I have more to share on the power of cardiac preventive care.

I was getting ready this week to go to Helsinki to teach our annual short-course on chronic disease prevention, and looking over the recent work done by my colleagues in Finland. I found an article by Pekka Jousilahti and Tiina Laatikainen reported in the BMJ. They report changes in coronary heart disease mortality rates that were associated with a comprehensive cardiac prevention program.

Between the years 1969-1972 and 2012, coronary heart disease mortality decreased by 82% among men and 84% among women aged 35-64 years, respectively. During the first 10 years, changes in blood pressure, smoking and serum cholesterol contributed to nearly all of the observed mortality reduction. What my colleagues told me, that is not in the article is this: over the same time period, life expectancy – most of it healthy – increased by 10 years for both men and women of middle age.

Since the mid-1980s, the observed reduction in mortality has been larger than predicted, but the majority of the decline was still attributable to primary prevention. This amazed me because in 1985 we thought that a 70% decline in mortality was as much as we could get with intervention.1

I’ve linked the BMJ article below. The Finnish experience is evidence that, given time and persistence, EvidenceNOW can extend the healthy life expectancies of tens of millions of Americans, and the ESCALATES evaluation – with the data cooperatives and their practices are sharing – can show others the outcome of this effort and how this happens.



  1. Kottke TE, Puska P, Salonen J T, Tuomilehto J, Nissinen A. Projected effects of high-risk versus population-based prevention strategies in coronary heart disease. Am J of Epidem. 1985;121(5), 697-704.