Mediterranean diet score: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study.
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Cohort Studies↗
Biomedical subjects
A Menotti
Publications and source records attributed to A Menotti.
Mediterranean Adequacy Index: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study.
BACKGROUND AND AIM: The Mediterranean Adequacy Index (MAI) is an overall indicator characterising a diet in comparison with a Reference Mediterranean Diet. We computed the MAI of random samples of men surveyed for their eating habits in the 16 cohorts of the Seven Countries Study, and found that it inversely correlated with the 25-year death rates from coronary heart disease in the 16 cohorts (R = -0.72; p = 0.001). The correlation coefficient was -0.84 (p < 0.001) when the MAI was converted into natural logarithms. CONCLUSIONS: These findings once again support the association between typical Mediterranean eating habits and protection against coronary heart disease.
Adult↗
Physical activity decreases the risk of stroke in middle-age men with left ventricular hypertrophy: 40-year follow-up (1961-2001) of the Seven Countries Study (the Corfu cohort).
Left ventricular hypertrophy (LVH) is a dominant characteristic of cardiovascular mortality. We investigated the interaction between physical activity and LVH on stroke mortality, based on a 40-year follow-up of the Corfu cohort from the Seven Countries Study. The population studied consisted of 529 rural men (40-59 years old) enrolled in the Study at 1961. LVH was electrographically confirmed according to Minnesota coding. Physical activity levels were assessed by self-reports of habitual, occupational and leisure-time activities. Cox proportional hazard models were used to evaluate exercise levels with respect to stroke mortality in people with and without LVH. During the follow-up, 461 (87%) died, and 74 (16%) of these deaths were due to stroke. LVH was present in 40 (7.5%) men. A total of 362 (68%) men were defined as physically active. Physical activity was associated with a lower risk of stroke (hazard ratio=0.65, P<0.05). On the other hand, LVH had 5.8-fold the risk of stroke (P<0.001) among sedentary and 4.5-fold the risk (P<0.001) among physically active men, after controlling for several potential confounders. However, moderate physical activity decreased the risk of stroke by 49% in men with LVH as compared to sedentary without LVH (hazard ratio=0.51, P<0.01), while hard exercise did not confer any significant reduction in stroke risk. We revealed the benefits from moderate physical activity on stroke mortality among men with LVH. Physicians and other health-care professionals should encourage patients with LVH to adopt a physically active lifestyle.
Adult↗
Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project.
AIMS: The SCORE project was initiated to develop a risk scoring system for use in the clinical management of cardiovascular risk in European clinical practice. METHODS AND RESULTS: The project assembled a pool of datasets from 12 European cohort studies, mainly carried out in general population settings. There were 20,5178 persons (88,080 women and 11,7098 men) representing 2.7 million person years of follow-up. There were 7934 cardiovascular deaths, of which 5652 were deaths from coronary heart disease. Ten-year risk of fatal cardiovascular disease was calculated using a Weibull model in which age was used as a measure of exposure time to risk rather than as a risk factor. Separate estimation equations were calculated for coronary heart disease and for non-coronary cardiovascular disease. These were calculated for high-risk and low-risk regions of Europe. Two parallel estimation models were developed, one based on total cholesterol and the other on total cholesterol/HDL cholesterol ratio. The risk estimations are displayed graphically in simple risk charts. Predictive value of the risk charts was examined by applying them to persons aged 45-64; areas under ROC curves ranged from 0.71 to 0.84. CONCLUSIONS: The SCORE risk estimation system offers direct estimation of total fatal cardiovascular risk in a format suited to the constraints of clinical practice.
Adult↗
Twenty-five-year coronary mortality trends in the seven countries study using the accelerated failure time model.
The 'accelerated failure time model' (AFT) was tested in the 25-year experience of the Seven Countries Study, to describe the shape of hazard for coronary heart disease (CHD) mortality during long-term follow-up. Sixteen cohorts of men aged 40-59 at entry were enrolled in eight countries (USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan) for a total of 12,763 subjects. Risk factors were measured and CHD mortality data collected during 25 years. The AFT incorporating the Weibull survival distribution was applied to the pooled cohorts of each country, with CHD mortality as endpoint. Cumulative hazards and the annual hazard for CHD mortality were estimated during 25 years and compared among countries. The annual hazard for CHD in 25 years tended to reduce relatively or flatten out in the northern American and northern European countries, exponentially increased in Serbia and Japan, and increased moderately in the other countries of southern Europe. Positive correlations were found between the shape of the hazard curve and population mean risk factor changes (serum cholesterol and systolic blood pressure) observed during the first 10 years follow-up. The Japanese group was an outlier. The countries with the largest relative decline in the annual hazard function were the same where, during the same historical period, the largest decreases in official death rates from CHD were recorded and vice versa. The curve shape in the annual hazard for CHD mortality in different countries seems related to changes in mean levels of serum cholesterol and systolic blood pressure.
Adult↗
Coronary risk factors predicting early and late coronary deaths.
OBJECTIVE: To study the time related association of a single measurement of coronary risk factors with coronary heart disease (CHD) deaths occurring during a very long follow up period in a population sample of middle aged men. DESIGN, SETTING, AND METHODS: Age, systolic blood pressure, serum total cholesterol, physical activity at work, body mass index, and cigarette smoking were measured once in 1622 CHD-free men aged 40-59 belonging to the Italian rural cohorts of the seven countries study. During 35 years of follow up 214 men died from CHD (sudden death and definite myocardial infarction). Seven partitioned proportional hazards models were solved, one for each independent five year block of follow up, to predict the risk of CHD death. RESULTS: The seven, five year partitioned hazard functions were cumulated and smoothed for each risk factor. The resulting curves showed a regularly increasing time trend in risk for coronary deaths as a function of age, serum cholesterol, systolic blood pressure, and cigarette smoking and a regularly decreasing risk for physical activity. The curves fit straight lines, with large squared correlation coefficients ranging from 0.92-0.97. This suggests a relatively constant strength in the association of risk factor levels with events, which are predicted whatever the length of time after risk factors were measured. These findings were not altered by adding to the models risk factor changes preceding the quinquennium of death. CONCLUSION: A single measurement of some coronary risk factors in middle aged men maintains a regular and almost monotonic relation with the occurrence of CHD deaths during 35 years of follow up.
Adult↗
Diet and 20-year chronic obstructive pulmonary disease mortality in middle-aged men from three European countries.
OBJECTIVE: To investigate the relation of baseline antioxidant, fruit, vegetable and fish intake with 20 y chronic obstructive pulmonary disease (COPD) mortality in middle-aged men from three European countries. DESIGN: Prospective study (1970-1990). SETTING: Five population-based cohorts of middle-aged men from Finland, Italy and The Netherlands. SUBJECTS: A total of 2917 men aged 50-69 y at baseline. METHODS: Baseline information on diet was collected using the cross-check dietary history method. After 20 y of follow-up the underlying cause of death of those who died was established centrally. Survival analyses were performed using the Cox Proportional Hazards Model. RESULTS: After adjustment for age, smoking and country, we observed an inverse trend (P-trend <0.05) of 20 y COPD mortality across tertiles of fruit and vitamin E intake. No trend was observed for vegetables, fish, vitamin C and beta-carotene. When modelled continuously, a 100 g increase in fruit intake was associated with a 24% lower COPD mortality risk (RR=0.76, 95% CI=0.60-0.92). For vitamin E intake (per 5 mg) the RR was 0.77 (95% CI=0.55-1.06), after adjustment for age, smoking and country. Additional adjustment for body mass index, total energy intake and alcohol consumption reduced the RR to 0.86 (95% CI=0.69-1.07, P=0.12) for fruit and 0.93 (95% CI=0.65-1.33) for vitamin E. CONCLUSIONS: Our results suggest a protective effect of fruit and possibly vitamin E intake against COPD. No effect was observed for intake of vitamin C, beta-carotene, vegetables and fish.
Adult↗
Predicting cardiovascular risk in the elderly in different European countries.
AIMS: The objective of this study was to develop risk functions for coronary heart disease and cardiovascular disease mortality for elderly men in different European countries. METHODS AND RESULTS: The FINE Study is a prospective follow-up study of 2170 elderly men aged 65-84 years in Finland, Italy and The Netherlands. During 10 years of follow-up 289 men died from coronary heart disease and 545 men from cardiovascular disease. Risk functions were estimated using logistic regression analysis, in order to take competing causes of death into account. The results of the present study show that total cholesterol and smoking were the most important predictors of coronary heart disease mortality, and HDL cholesterol, systolic blood pressure and smoking of cardiovascular disease mortality. Left ventricular hypertrophy, being subject to coronary heart disease or cardiovascular disease in Finland and The Netherlands and use of antihypertensive medication in Italy, were also important predictors. For estimating the absolute risk of coronary heart disease and cardiovascular disease mortality in the elderly it is necessary to take into account the European country in which they live. CONCLUSION: Total and HDL cholesterol, systolic blood pressure and smoking remain important predictors of coronary heart disease and/or cardiovascular disease mortality in elderly men, but also left ventricular hypertrophy, being subject to coronary heart disease, use of antihypertensive medication and country are predictive of coronary heart disease and cardiovascular disease risk.
Aged↗
Cohort analysis of fruit and vegetable consumption and lung cancer mortality in European men.
Our aim was to examine the relationship between fruit and vegetable consumption and lung cancer mortality in a cohort of European males. Around 1970, dietary intake of Finnish, Italian and Dutch middle-aged men was assessed using a cross-check dietary history. Complete baseline information was available for 3,108 men, of whom 1,578 were baseline smokers. We used Cox proportional hazard analyses to calculate risk estimates for the consumption in country-specific tertiles on lung cancer in smokers. During 25 years of follow-up, 149 lung cancer deaths occurred in the smokers. Fruit consumption was inversely associated with lung cancer mortality among smokers; compared with the lowest, adjusted RRs for the intermediate and highest tertiles were 0.56 (0.37-0.84) and 0.69 (0.46-1.02), p-trend 0.05. Only in the Dutch cohort was this association statistically significant [adjusted relative risks (RRs) 1.00, 0.33 (0.16-0.70) and 0.35 (0.16-0.74), p-trend 0.004]. In Finland lung cancer risk was lower with higher fruit intake but not significantly, whereas in Italy no association was observed. Stratifying on cigarette smoking intensity (non, light and heavy) revealed an inverse association in the heavy smokers only [adjusted RRs (95% confidence intervals [CI]) 1; 0.47 (0.26-0.84); 0.40 (0.20-0.78)). Vegetable consumption was not related to lung cancer risk in smokers. However, analyses stratified on cigarette smoking intensity gave some indication for a lower lung cancer risk with higher intake. In conclusion, in this prospective analysis among European smoking men, fruit intake was inversely related to lung cancer mortality. This association was confined to heavy cigarette smokers.
Adult↗
Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly).
Older males are known to carry, more likely than younger people, one or more chronic diseases with an expected impact on mortality. This study was aimed at identifying the relationship of prevalent chronic diseases in elderly populations of different countries with all-cause mortality. Men aged 65-84 from defined areas were enrolled in Finland (N=716), the Netherlands (N=887) and Italy (N=682). They were survivors of cohorts studied for 25 years within the Seven Countries Study. Major chronic diseases were diagnosed at entry. Ten-year follow-up for mortality was completed. Entry prevalence of selected chronic diseases was higher in Finland (56%) than in Italy (51%) and the Netherlands (44%). Ten-year age-adjusted death rates from all causes were higher in Finland (565 per 1000) and lower in the Netherlands (478 per 1000) and Italy (445 per 1000). The absolute risk of death related to chronic disease was high in the three countries, but was higher in Finland than in the Netherlands and Italy. The most lethal condition was stroke, with 10-year death rates of 806 per 1000 in Finland and 707 and 729 per 1000 in the Netherlands and Italy, respectively. The relative risk of all-cause mortality for a set of seven chronic diseases (coronary heart disease, heart failure, claudicatio intermittens, cerebrovascular accidents, diabetes, COPD and cancer) adjusted by age, other diseases and cohort was less than two for each condition, except cerebrovascular accidents in the Netherlands (RR 2.20). In general, relative risk was higher in Finland, intermediate in the Netherlands and lower in Italy, where only cerebrovascular accidents, intermittent claudication, diabetes and the presence of any chronic condition had a significant relative risk. About one third of men had one chronic disease, and between 10% and 15% had two diseases. The coexistence of any two or three chronic conditions was associated with a relative risk of 2 or more in Finland and the Netherlands and less than 2 in Italy. In these elderly men prevalent morbidity and comorbidity was relatively common and it explained a large proportion of excess in all-cause mortality in 10 years of follow-up.
Aged↗
Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study.
This analysis aims at describing all-cause mortality and their determinants in 16 cohorts of middle-aged men of eight nations. A total of 12,763 men aged 40-59 years were enrolled in the late 1950s and early 1960s in 16 cohorts located in the USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan. The highest death rates were found in Slavonia-Croatia, due to high rates of infectious diseases and violence (death rate of 610 per 1000), and in East Finland due to high rates from coronary heart disease (death rate of 597 per 1000). The lowest death rates were found in a highly educated group in Belgrade, Serbia (death rate 295 per 1000) and in Crete, Greece (death rate 314 per 1000). The ecological analysis showed no significant relationship between mean risk factor levels and all-cause death rates except for the direct association with systolic blood pressure during the first 15 years follow-up. Individual multivariate analysis on eight national pools showed that age, systolic blood pressure, and smoking habits are direct, significant, and universal long-term predictors of all-cause mortality. Serum cholesterol, physical activity and body mass index were so only in some areas. Multivariate coefficients were similar across nations. Pooled hazards ratios were 1.55 for a difference of 5 years of age (CI: 1.51-1.59); 1.23 for 10 cigarettes smoked per day (CI: 1.20-1.26); 0.91 for one unit (based on three grades) of physical activity score (CI: 0.87-0.95); 1.04 for 1 mmol/l of serum cholesterol (CI: 1.02-1.07); and 0.93 for three units of body mass index (CI: 0.91-0.96). In conclusion some cardiovascular risk factors predict long-term risk of all-cause mortality in different cultures.
Adult↗
Physical activity and dietary fiber determine population body fat levels: the Seven Countries Study.
BACKGROUND: A global epidemic of obesity is developing. Current prevalence rates are about 20-25% in American adults and 15-20% in Europeans. OBJECTIVE: We investigated the association between population levels of physical activity, dietary fat, dietary fiber and indicators of body fat. DESIGN: Cross-cultural study of 16 cohorts of, in total, 12 763 middle-aged men in seven countries. These men were examined between 1958 and 1964. MEASUREMENTS: Height, weight and subscapular skinfold thickness were measured. Information about job-related physical activity and diet was gathered by questionnaire. RESULTS: The population average body mass index (weight/height) varied between 21.8 and 26.0 kg/m2 and the population average subscapular skinfold thickness between 8.4 and 23.7 mm. The population average physical activity index and dietary fiber intake were both strongly inversely related to population average subscapular skinfold thickness and explained together 90% of the variance in subscapular skinfold thickness. Similar but less strong results were obtained for average population body mass index. CONCLUSION: At the population level job-related physical activity and dietary fiber but not dietary fat, are important determinants of subscapular skinfold thickness.
Adipose Tissue↗
Arginine intake and 25-year CHD mortality: the Seven Countries Study.
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Adult↗
Cardiovascular risk factors and 10-year all-cause mortality in elderly European male populations; the FINE study. Finland, Italy, Netherlands, Elderly.
BACKGROUND: This study aims to examine cardiovascular risk factors in relation to all-cause mortality in elderly populations of different European countries. METHODS: Men aged 65--84 years from defined administrative areas were enrolled in Finland (rural areas of east and west Finland; n=716), in the Netherlands (the town of Zutphen; n=887), and in Italy (the rural areas of Crevalcore and Montegiorgio; n=682). Ten-year all-cause mortality was studied in relation to measurements taken at entry: age, systolic blood pressure, HDL- and non-HDL-cholesterol, body mass index, heart rate and smoking habits. Univariate and multivariate analyses were performed with all-cause mortality as the end-point. RESULTS: Ten-year death rates from all causes were higher in Finland (574 per 1000), lower in the Netherlands (475 per 1000), and Italy (466 per 1000). Age, heart rate and smoking in all three countries were independently associated with 10-year all-cause mortality. Non-HDL-cholesterol was not related with all-cause mortality. The observed associations between HDL-cholesterol, systolic blood pressure, body mass index and all-cause mortality were dependent on the in- or exclusions of early death. CONCLUSION: In these elderly men only age, smoking habits and heart rate were consistently associated with all-cause mortality.
Age Factors↗
Relation between blood pressure and mortality: is there a threshold?
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Age Factors↗
Alcohol consumption in relation to 20-year COPD mortality and pulmonary function in middle-aged men from three European countries.
Alcohol consumption shows a U-shaped relation with all-cause and cardiovascular mortality. To determine whether a similar relation exists between alcohol and chronic obstructive pulmonary disease mortality, we analyzed data on alcohol consumption in 1970 and 20-year mortality from chronic obstructive pulmonary disease among 2,953 middle-aged men from Finland, Italy, and the Netherlands. We also studied alcohol consumption in relation to pulmonary function (FEV1 or FEV0.75) at baseline. We used regression models adjusted for age, height (for pulmonary function only), body mass index, smoking habits, energy intake, and country. A smoothed spline-plot showed a U-shaped relation between alcohol and chronic obstructive pulmonary disease mortality. Compared with non-drinkers and occasional drinkers, the relative risk of chronic obstructive pulmonary disease mortality was 0.60 (95% CI = 0.33-1.09) in light drinkers (> 1 drink per week, < or = 3 drinks per day) and 1.25 (95% CI = 0.47-3.31) in moderate-to-heavy drinkers. Pulmonary function was lower in non-drinkers compared with occasional and light drinkers in Finland (75 ml, 95% CI = -2 to 151) and the Netherlands (93 ml, 95% CI = 0-186) and lower in very heavy (> 12 drinks per day) compared with moderate-to-heavy drinkers in Italy (99 ml, 95% CI = 9-189). In conclusion, we observed a U-shaped curve between alcohol consumption and 20-year chronic obstructive pulmonary disease mortality in middle-aged men that was supported by cross-sectional data on alcohol and pulmonary function.
Adult↗
Impact of the Gubbio population study on community control of blood pressure and hypertension. Gubbio Study Research Group.
BACKGROUND: Awareness and treatment of hypertension have markedly increased in the last 30 years in most parts of the world, but a satisfactory control of blood pressure is still infrequent OBJECTIVES: To describe trends in community control of hypertension and blood pressure levels in the small town of Gubbio, Italy. METHODS: Large samples of the populations (aged 30-79 years) were examined 6 years apart for measurement of blood pressure, other cardiovascular risk factors and knowledge, attitude and practice towards control of hypertension. Data were available from a total of 1125 men and 1445 women with two examinations and 1566 men and 1658 women with at least one examination. Two different definitions of hypertension were used (old definition: systolic blood pressure (SBP) > or = 160 mmHg or diastolic blood pressure (DBP) > or = 95 mmHg or use of antihypertensive drugs; recent definition: SBP > or = 140 mmHg or DBP > or =90 mmHg or use of anti-hypertensive drugs). RESULTS: Awareness, treatment and control of hypertension increased from one survey to the other, whatever definition of hypertension was used. Control rose from 41 to 63% (old definition) and from 12 to 24% (recent definition). In a 6-year period, the average population SBP declined 2-8 mmHg and DBP declined 2-3 mmHg depending on type of analysis, against an expected rise of 9 mmHg for SBP and 2 mmHg for DBP. These trends are partly explained by a marked decline in alcohol consumption and by more common and intensive anti-hypertensive treatment, while change in body mass index, which showed a slight but systematic increase, cannot be considered as a contributor to this trend. CONCLUSIONS: An epidemiological study has motivated a population group and its medical profession towards a better control of hypertension.
Adult↗
The duration of the association between serum cholesterol and coronary mortality: a 35-year experience.
OBJECTIVE: Our purpose was to study the time-related association between a single measurement of total serum cholesterol and the occurrence of coronary deaths in a population sample of middle-aged men. DESIGN: This is a longitudinal population study with multiple measurements of serum cholesterol and a 35-year follow-up for coronary mortality in 1622 coronary disease-free men aged 40-59 years belonging to the Italian rural cohorts of the Seven Countries Study. METHOD: A single measurement of serum cholesterol (plus those of five other risk factors as possible confounders) was considered. During 35 years of follow-up, 214 men died from coronary heart disease. Annual partitioned proportional hazards models were solved, one for each independent year of follow-up, to predict the risk of coronary heart disease deaths. Single-year hazard functions were cumulated and smoothed. Similar analyses were made starting from cholesterol measurements taken at years 5, 10 and 20 of follow-up. RESULTS: The resulting hazard curves showed regularly increasing risk for coronary events and fitted straight lines with large correlation coefficients, demonstrating a strong association of serum cholesterol with both early and late events. The slopes were steeper for cholesterol measurements taken at younger ages. The slope for cholesterol measurement taken at year 20 (age 60-84 years) was flat. In slopes starting at an early age, two components could be isolated corresponding to different associations with events (stronger for early events when measurements were taken around the age of 50 years and for late events when measurements were taken around the age of 55 or 60 years). CONCLUSION: A single measurement of total serum cholesterol in middle-aged men maintains a relatively monotone relationship with the occurrence of coronary heart disease deaths over 35 years. In the study population, measurements taken in late adulthood had smaller or null association with coronary disease deaths.
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