Determinants of 40-year all-cause mortality in the European cohorts of the Seven Countries Study

Abstract

If a few risk factors had predictive power for all-cause mortality in different geographical-cultural areas, then preventive efforts might be concentrated on these. Thirteen potential risk factors were measured in 6,554 men aged 40-59 around 1960 in Northern, Southern and Eastern European areas of the Seven Countries Study. In 40 years 85.3% of men died in the pooled areas (87.9, 81.8 and 87.9% in Northern, Southern and Eastern Europe, respectively). Six risk factors were significant predictors of events in all three areas: directly for age, smoking habits, mean blood pressure, heart rate and ECG abnormalities; inversely for forced expiratory volume. In a pooled model also father and mother life status, socio-economic status, and arm circumference (the last one in an inverse way) had significant coefficients that were not heterogeneous across areas (except for socio-economic status). Serum cholesterol was around significance. ROC curves had values of 0.833, 0.806 and 0.819 respectively in Northern, Southern and Eastern Europe, and 0.827 in the pooled areas. Correlation coefficients between observed and expected cases in deciles of estimated risk were between 0.98 and 0.99. Survivors after 40 years in the lower half of the estimated risk were 10.7, 23.6 and 13.3% in Northern, Southern and Eastern Europe, respectively. Under- or over-estimate of cross-applying risk functions did not exceed 15%. All-cause mortality and survival in middle aged men during 40 years were strongly associated with a few, mainly cardiovascular, risk factors, whose predictive power was similar in different cultures across Europe.

Metabolic syndrome among children and adolescents from Southern Italy: Contribution from the Calabrian Sierras Community Study (CSCS)

“…1, 2 and Supplementary tables 1-6) and they might be used both for comparative and applicative purposes in the age range of 6-14 years in investigations from Italy [21] and probably from Southern Europe [19][20][21] since the population wherefrom the data were obtained is a residential community in a well defined geographic area [8,9]. However, especially in the lower age ranges it should be important to accrue the representativeness [15] of the population which is for further studies to be launched.…”

“…It assessed BP values in a residential pediatric community and defined cut-off limits previously referred to European standards derived from US pediatric population surveys [16], a situation that created overestimates in meta-analytical results [17]. Probably not different from middle-aged populations, there might be a major flaw that Northern European or Northern American standards could not be suitable for a children population with different lifestyle, diet habits and prevalence of obesity such as one from Southern Europe to which Southern Italy definitely concur [18][19][20]. In CSCS systolic BP was 101 ± 11 (interval 60-150) mm Hg (much lower than previously reported in comparable age and gender groups) and cholesterol levels were 156 ± 28 (interval of 57-264) mg/dl.…”

Natural history of coronary heart disease and heart disease of uncertain etiology: Findings from a 50-year population study

“…This analysis was based on the best possible attempt to reconstruct coronary heart and non-coronary disease incidences, using standardized methods previously adopted and described [8][9][10][11][12][13]24] along 50 years of follow-up exploiting all the available data and information. The authors are aware that there were incompleteness and imprecision, partly presented beforehand.…”

“…Major heart disease events or first diagnoses were classified into two large groups, arbitrarily named respectively CHD and HDUE, using information from periodical examinations, special search and mortality data including secondary causes [8][9][10][11]. There were cases of: a) CHD including: sudden coronary death (when other causes could reasonably be excluded), definite fatal and non-fatal myocardial infarction, and other acute coronary syndromes; the latter arbitrary term includes cases when typical history was not accompanied by the occurrence of a Q wave and it corresponds to other common terms such as possible myocardial infarction, minor infarction, intermediate syndrome, acute ischemic attack and non-Q myocardial infarction used in successively historic time periods also depending on the state of the art knowledge, opinion leaders' preferences or simply different disciplines [22][23][24][25][26][27]; b) HDUE including: heart failure, diagnoses of hypertensive heart disease, or "chronic" CHD, severe arrhythmia (such as stable atrial fibrillation), severe heart blocks (possibly leading to the implant of a pace-maker), all these in the absence of manifestations described as CHD.…”

“…The Italian Rural Areas (IRA), as part of the Seven Countries Study (SCS), a large classic of international cardiovascular epidemiology [8,10], have been analyzed in reference to 40-and 50-year follow-up [9,12,13]. The IRA study obtained a full long-term measure of incident events including fatalities.…”