Skip to main content

Advertisement

SpringerLink
Log in

Age at death in elderly cohorts of four European countries of the Seven Countries Study: the role of comorbidities

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Purpose

To study age at death (AD) in elderly men as a function of risk factors and morbid conditions in a 25-year follow-up.

Materials and methods

Men enrolled in the Seven Countries Study belonging to 8 cohorts in 4 European countries (Finland, The Netherlands, Italy and Serbia) were examined between 1984 and 1989 (aged 65–84 years) with measurement of some cardiovascular risk factors and recording of a few major morbid conditions. AD was measured after 25-year follow-up and used in multiple linear regression (MLR) models as dependent variable; while, risk factors and morbid conditions had the role of independent variables.

Results

Out of 2457 men, 2290 died during 25-year follow-up. Overall mean AD was of 82.0 years and slightly different across cohorts, the lowest being recorded in Finland. Age at entry examination and HDL cholesterol were directly associated with AD; while, blood pressure, heart rate, smoking habits and morbid conditions (major cardiovascular diseases, either independently or combined together with diabetes, chronic bronchitis, cancer and silent ECG abnormalities) were inversely related to AD. Body mass index had a parabolic relation with AD with longer survival for levels around 24 units; while, total serum cholesterol was not related to AD. However, only three independent variables were statistically significant when tested in each individual country (age, heart rate and stroke). In a MLR model, where a comorbidity score was entered as independent variable (everything else being equal), the presence of 1 morbid condition was associated with a reduced AD by 1.87 years that increased up to 6.39 years when 4 morbid conditions were present.

Conclusion

AD seems a valuable indicator of all-cause mortality when the study population has reached or approached the extinction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Canudas-Romo V (2008) The modal age at death and the shifting mortality hypothesis. Demog Res 19:1179–1204

    Article  Google Scholar 

  2. Horiuchi S, Ouellette N, Cheung SLK, Robine JM (2013) Modal age at death: lifespan indicator in the era of longevity extension. Vienna Yearbook Populat Res 2:37–69

    Google Scholar 

  3. Wrycza TF, Missov TI, Baudisch A (2015) Quantifying the shape of aging. PLoS ONE 10:e0119163

    Article  Google Scholar 

  4. Robine JM (2018) Age at death, the return of an old metric whose importance is growing. Aging Clin Exp Res 30:1147–1149

    Article  Google Scholar 

  5. Menotti A, Puddu PE, Tolonen H, Kafatos A (2018) Age at death in cohorts of middle-aged men followed-up until nearly extinction: The European Areas of the Seven Countries Study. Ann Med 50:620–633

    Article  Google Scholar 

  6. Menotti A, Puddu PE, Maiani G, Catasta G (2018) Age at death as a useful indicator of healthy aging at population level: a 50-year follow-up of the Italian rural areas of the seven countries study. Aging Exper Clin Res 30:901–911

    Article  Google Scholar 

  7. Menotti A, Puddu PE, Tolonen H, Adachi H, Kafatos A, Kromhout D (2019) Age at death of major cardiovascular diseases in 13 cohorts. The Seven Countries Study of cardiovascular diseases 45-year follow-up. Acta Cardiol 74:66–72

    Article  Google Scholar 

  8. Keys A, Blackburn H, Menotti A, Buzina R, Mohacek I, Karvonen MJ, Punsar S, Aravanis C, Corcondilas A, Dontas AS, Lekos D, Fidanza F, Puddu V, Taylor HL, Monti M, Kimura N, Van Buchem FSP, Djordjevic BS, Strasser T, Anderson JT, Den Hartog C, Pekkarinen M, Roine P, Sdrin H (1970) Coronary heart disease in seven countries. Circulation 41(suppl 1):1–211

    Google Scholar 

  9. Keys A, Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Karvonen MJ, Kimura N, Menotti A, Mohacek I, Nedeljkovic S, Puddu V, Punsar S, Taylor HL, Van Buchem F (1980) Seven Countries Study. A multivariate analysis of death and coronary heart disease. Harvard Univ Press, Cambridge Mass 1–381

  10. Kromhout D, Menotti A, Blackburn H. Prevention of coronary heart disease. Diet, lifestyle and risk factors in the Seven Countries Study. Kluwer Publ. Norwell Ma, USA and Dordrecht, 2002: 1–267

  11. Rose G, Blackburn H (1968) Cardiovascular survey methods. World Health Organization, Geneva, pp 1–188

    Google Scholar 

  12. Kromhout D, Nissinen A, Menotti A, Bloemberg B, Pekkanen J, Giampaoli S (1990) Total and HDL cholesterol and their correlates in elderly men in Finland, Italy and the Netherlands. Am J Epidemiol 131:855–863

    Article  CAS  Google Scholar 

  13. Fairbairn AS, Wood CH, Fletcher CM (1959) Variability in answers to a questionnaire on respiratory symptoms. Brit J Prev Soc Med 13:175–193

    CAS  Google Scholar 

  14. Menotti A, Mulder I, Nissinen A, Feskens E, Giampaoli S, Tervahauta M, Kromhout D (2001) Cardiovascular risk factors and 10-year all-cause mortality in elderly European male populations. FINE Study Eur Heart J 22:573–579

    Article  CAS  Google Scholar 

  15. Menotti A, Mulder I, Kromhout D, Nissinen A, Feskens EJM, Giampaoli S (2001) The association of silent electrocardiographic findings with coronary deaths among elderly men in three European countries. FINE Study Acta Cardiol 56:27–36

    Article  CAS  Google Scholar 

  16. Menotti A, Mulder I, Nissinen A, Giampaoli S, Feskens EJ, Kromhout D (2001) Prevalence of morbidity and multimorbidity in eldelrly male population and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly). J Clin Epidemiol 54:680–686

    Article  CAS  Google Scholar 

  17. Lanti M, Puddu PE, Terradura Vagnarelli O, Laurenzi M, Cirillo M, Mancini M, Zanchetti A, Menotti A (2015) Antihypertensive treatment is not a risk factor for major cardiovascular events in the Gubbio residential cohort study. J Hypertens 33:736–744

    Article  CAS  Google Scholar 

  18. Puddu PE, Piras P, Menotti A (2016) Competing risks and lifetime coronary heart disease incidence during 50 years of follow-up. Int J Cardiol 219:79–83

    Article  Google Scholar 

  19. Puddu PE, Piras P, Menotti A (2017) Lifetime competing risks between coronary heart disease mortality and other causes of death during 50 years of follow-up. Int J Cardiol 228:359–363

    Article  Google Scholar 

  20. Menotti A, Puddu PE (2015) Lifetime prediction of coronary heart disease and heart disease of uncertain etiology in a 50-year follow-up population study. Int J Cardiol 196:55–60

    Article  Google Scholar 

  21. Puddu PE, Menotti A (2015) Natural history of coronary heart disease and heart disease of uncertain etiology: findings from a 50-year population study. Int J Cardiol 197:260–264

    Article  Google Scholar 

  22. Aune D, Sen A, O’Hartaigh B, Janszky I, Romundstad PR, Tonstad S, Vatten LJ (2017) Resting heart rate and the risk of cardiovascular disease, total cancer, and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 27: 504–517

  23. Menotti A, Puddu PE, Maiani G, Catasta G (2015) Lifestyle behaviour and lifetime incidence of heart disease. Int J Cardiol 201:293–299

    Article  Google Scholar 

  24. Menotti A, Puddu PE, Maiani G, Catasta G (2016) Cardiovascular and other causes of death as a function of lifestyle habits in a quasi-extinct middle-aged male population A 50-year follow-up study. Int J Cardiol 210:173–178

    Article  Google Scholar 

  25. Sans S (2018) Mediterranean diet, active lifestyle and cardiovascular disease: A recipe for immortality? Eur J Prev Cardiol 25:1182–1185

    Article  Google Scholar 

  26. Alvarez-Alvarez I, de Rojas JP, Fernandez-Montero A, Zazpe I, Ruiz-Canela M, Hidalgo-Santamaría M, Bes-Rastrollo M, Martínez-González MÁ (2018) Strong inverse associations of Mediterranean diet, physical activity and their combination with cardiovascular disease: The Seguimiento Universidad de Navarra (SUN) cohort. Eur J Prev Cardiol 25:1186–1197

    Article  Google Scholar 

Download references

Acknowledgements

The authors express their gratitude to Prof Daan Kromhout, University of Groningen, The Netherlands, for allowing the use of the Dutch data of the Seven Countries Study, and to the late Prof Srecko Nedeljkovic, University of Belgrade, Serbia for his high professional and enthusiastic action in collecting data for Serbia.

Funding

The present investigation received no funding. The initial field examination was held only a few months after the Helsinki Declaration and acceptance from the subjects was implied in participation. All methods were carried out in accordance with relevant guidelines and regulations at the time of the study start, although institutional or licensing committees were not still present in the Country and accordingly were not consulted.

Author information

Authors and Affiliations

  1. Association for Cardiac Research, Via Savoia, 78, 00198, Rome, Italy

    Alessandro Menotti & Paolo Emilio Puddu

  2. EA (Equipe d’Accueil) 4650: Signalisation, électrophysiologie et imagerie des lésions d’ischémie reperfusion myocardique, Université de Normandie, 14100, Caen, Normandie, France

    Paolo Emilio Puddu

  3. Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland

    Hanna Tolonen

Authors
  1. Alessandro Menotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paolo Emilio Puddu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hanna Tolonen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paolo Emilio Puddu.

Ethics declarations

Conflict of interest

None of the authors report any conflict of interests in relation to this MS and related analyses.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all subjects during subsequent examinations.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Menotti, A., Puddu, P.E. & Tolonen, H. Age at death in elderly cohorts of four European countries of the Seven Countries Study: the role of comorbidities. Aging Clin Exp Res 33, 521–528 (2021). https://doi.org/10.1007/s40520-020-01568-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-020-01568-2

Keywords

Search

Navigation