European Journal of Epidemiology

, Volume 8, Issue 4, pp 601–608 | Cite as

Progetto ATENA, A study on the etiology of major chronic diseases in women: Design, rationale and objectives

  • S. Panico
  • R. Dello Iacovo
  • E. Celentano
  • R. Galasso
  • P. Muti
  • M. Salvatore
  • M. Mancini


In spite of their important impact on populations, a number of diseases - all types of cancer and coronary heart disease in women - are “rare” events for statistical analysis and often analyzed in designs affected by selection and information biases, such as case-control studies. Large cohort studies based on the storage of biological specimens appear to be the most suitable solution for identifying risks for those diseases.

Progetto ATENA, a study on the etiology of major chronic diseases in women is based on this design. Ten thousand women, aged 30–69 years, living in the area of the city of Naples, free of cancer and cardiovascular disease, are being recruited over a four-year period. Ten per cent of the cohort is being randomly selected from the electoral roles, the rest will be volunteers.

Information on dietary habits, reproductive history, familiarity for chronic disease, active smoking habits and passive smoking exposure, physical activity, and socio-demographic data are being collected. Clinical data such as blood pressure, anthropometry, and electrocardiogram are also taken. All the participants provide biological samples of blood (fasting drawing) and urine (timed morning spot). The biological samples are processed in order to explore the main areas under study (nutritional markers, metabolism, endocrinology, genetics, environmental exposure markers, thrombogenesis). The samples are stored in liquid nitrogen (−196° C) as soon as the blood and urine processing have been finished. An appropriate follow-up information system on the health status of the participants is being set up to estimate incidence and mortality rates.

Key words

Epidemiology Cardiovascular diseases Cancer Women Biological bank Epidemiological projects 


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  1. 1.
    Berrino F., Bolelli G.F., Franceschetti F., Sciajno R., Pisani P., Micheli A. and Muti P. (1990): ORDET Project: validity of biological samples stored for prospective studies on diet, hormones and cancer -IARC Report of a meeting. October 12th, 1990.Google Scholar
  2. 2.
    Berrino F., Pisani P., Muti P., Crosignani P., Panico S., Pierotti M., Secreto S., Totis A., Fissi R. and Mazzoleni C. (1988): Prospective study on hormones and diet in the etiology of breast cancer. In: Riboli E. and Saracci R. (eds) - Diet, Hormones and Cancer: Methodological Issues for Prospective Studies -IARC Technical Report No.4 - pp.34–38, Lyon.Google Scholar
  3. 3.
    Berrino F., Pisani P., Muti P. and Panico S. (1987): L'enigma del cancro della mammella. In: Epidemiologia del cancro della mammella. Stato dell'arte 1987 - pp.151–157 - TEMI Editrice, Trento.Google Scholar
  4. 4.
    Bonita R., Stewart A. and Beaglehole R. (1990): International trends in stroke mortality 1970–1985 -Stroke 21: 989–992.Google Scholar
  5. 5.
    Breslow N.E. and Patton J. (1979): Case-control analysis of cohort studies. In: Breslow N.E. and Whittemore A.S. (eds) - Energy and Health: 226–242- SIAM, Philadelphia.Google Scholar
  6. 6.
    Capocaccia R., Farchi G., Mariotti S., Yerdecchia A., Angeli A., Scipione R., Feola G. and Morganti P. (1990): La mortality in Italia nell'anno 1987 -Rapporti ISTISAN 90/18, Roma.Google Scholar
  7. 7.
    Cauley J.A., Gutay J.P., Kuller L.H. and Dai W.S. (1987): Usefulness of steroid hormone levels in predicting coronary artery disease in men - Am. J. Cardiol. 60: 771–777.Google Scholar
  8. 8.
    Correa P., Fontham E., Pickle L.W., Chen V., Lin Y. and Haenszel W. (1985): Dietary determinants of gastric cancer in South Louisiana inhabitants - JNCI 75: 645–654.Google Scholar
  9. 9.
    Eacker E.D., Packard B., Wenger N.K., Clarkson T.B. and Tyroler T.A. (1987): Coronary heart disease in women - Proceedings of aNIH Workshop Haymarket - Doyma Inc., New York.Google Scholar
  10. 10.
    Giampaoli S., Menotti A., Righetti G. and Yerdecchia A. (1990): Sorveglianza degli eventi coronanci e cerebrovascolari. L'esperienza e gli insegnamenti dell'Area Latina del Progetto MONICA - G. Ital. Cardiol. 20: 267–271.Google Scholar
  11. 11.
    Giampaoli S., Menotti A., Urbinati G. C., Pannozzo F., Pasquali M., Morisi G., Buongiorno A.M., Dima F., Santaquilani A., Lo Noce C., Lombari P. e il Gruppo di Ricerca del Progetto Di.S.Co. (1990): Il Progetto Distretto Sezze Controllo Comunitario delle malattie cronico-degenerative (Di.S.Co.): dati relativi al secondo screening di popolazione. Rapporti Istisan 90/16.Google Scholar
  12. 12.
    Gruppi di ricerca ORDET-ATENA. Confronto tra determinazioni nelle urine raccolte in 12 ore vs urine raccolte “on the spot” per alcuni analiti di interesse negli studi eziologici sulle malattie cronicodegenerative (in preparation).Google Scholar
  13. 13.
    Gruppo di Ricerca CNR-ATS-RF2 (1980): I fattori di rischio dell'arteriosclerosi in Italia - La fase A del Progetto finalizzato del CNR “Medicina preventiva-Aterosclerosi-RF2” - G. Ital. Cardiol. X (Supp.3).Google Scholar
  14. 14.
    Gruppo di ricerca CNR-OB43 (1987): I fattori di rischio cardiovascolare in Italia - Aggiornamento agli anni 80 dello studio delle nove comunità -Cardiologia Preventiva e Riabilitativa 5: 75–137.Google Scholar
  15. 15.
    Inter-Society Commission for Heart Disease Resources (1970): Atherosclerosis Study Group and Epidemiology Study Group: Primary Prevention of the atherosclerotic diseases - Circulation 42: A55-A95.Google Scholar
  16. 16.
    Johansson S., Vedin A. and Wilhelmsson C. (1983): Myocardial infarction in women - Epidemiol. Rev. 5:65–95.Google Scholar
  17. 17.
    Kolata G. (1984): A new kind of epidemiology -Science 224: 481.Google Scholar
  18. 18.
    Kupper L.L., McMichael A.J. and Spiritas R. (1975): A hybrid epidemiologic study design using in estimating relative risk - J. Am. Stat. Ass. 45:524–528.Google Scholar
  19. 19.
    MacMahon S., Peto R., Cutler J., Collins R., Sorlie P., Neaton J., Abbott R., Godwin J., Dyer A. and Stamler J. (1990): Blood pressure, stroke, and coronary heart disease: part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias - Lancet 335: 765–774.Google Scholar
  20. 20.
    Malmgren R., Warlow C., Bamford J. and Sandercock P. (1987): Geographical and secular trends in stroke incidence - Lancet i: 1196–1200.Google Scholar
  21. 21.
    Mantel N. (1973): Synthetic retrospective studies and related topics - Biometrics 29: 479–486.Google Scholar
  22. 22.
    Menotti A., Giampaoli S., Yerdecchia A., Cesana G.C., Feruglio G.A., Righetti G., Ferrario M. and Vanuzzo D. (1989): II Progetto MONICA (monitoraggio malattie cardiovascolari). Protocollo e manuale delle aree italiane - Rapporti ISTISAN 89/12, Roma.Google Scholar
  23. 23.
    Micheli A., Muti P., Berrino F., Panico S., Secreto G., Recchione C., Pisani P., Totis A., Fissi R. and Cavalleri A. (1991): Serum and urinary androgens: repeated measurements in pre-menopausal and postmenopausal women - J. Clin. Epidemiol. 44:1055–1061.Google Scholar
  24. 24.
    Miettinen O.S. (1976): Estimability and estimation in case-referent studies - Am. J. Epidemiol. 103 (2): 226–236.Google Scholar
  25. 25.
    Muir C., Waterhouse S., Mack T., Powell J. and Whilan S. (1987): Cancer Incidence in Five Continents, Vol 5 - IARC Scientific Publications No. 88 - Lyon.Google Scholar
  26. 26.
    Panico S. (1991): Studies of coronary heart disease in women: Methodological issues in design. Paper presented at the meeting “U.S. and Italian studies in cardiovascular epidemiology” SUNY at Buffalo, N.Y. October 11th, 1991.Google Scholar
  27. 27.
    Panico S. (1991): Women and ischemic heart disease. In: European Prospective Studies on Nutrition, Cancer, and Health: Opportunities for Cardiovascular Studies. Technical Report IARC (in press).Google Scholar
  28. 28.
    Panico S., Galasso R., Celentano E., Caldara A., Buglione G. and Mancini M. (1991): Reliability of telephone versus face-to-face 24-hour recall on nutritional habits - 24th Annual meeting of the Society for Epidemiologic Research abs. no. 236.Google Scholar
  29. 29.
    Panico S., Muti P., Pisani P., Secreto G. and Berrino F. (1987): Hormones and diet in breast cancer etiology: ORDET Study - Feasibility studies and preliminary results. In: Castagnetta L. and Nenci I. (eds) -Biology and Biochemistry of Normal and Cancer Cell Growth - pp. 249–254 - Harwood Academic Publisher, London.Google Scholar
  30. 30.
    Panico S., Pisani P., Muti P., Recchione C., Totis A. and Berrino F. (1990): Diurnal variation: a source of bias in comparative studies - J. Endocrinol. Invest. 13: 423–426.Google Scholar
  31. 31.
    Phillips G.B., Yano K. and Stemmermann G.N. (1988): Serum sex hormone levels and myocardial infarction in the Honolulu Heart Program. Pitfalls in prospective studies on sex hormones - J. Clin. Epidemiol. 41: 1151–1156.Google Scholar
  32. 32.
    Prentice R. (1986): A case-cohort design for epidemiologic cohort studies and disease prevention trials - Biometrika 73: 1–11.Google Scholar
  33. 33.
    Prineas R., Crow R. and Blackburn H. (1982): The Minnesota Code Manual of Electrocardiographic Findings. Laboratory of Physiological Hygiene -School of Public Health - University of Minnesota, 1982.Google Scholar
  34. 34.
    Report of a WHO Expert Committee (1986): Community Prevention and Control of Cardiovascular Diseases - Technical Report Series No 732, World Health Organization, Geneva.Google Scholar
  35. 35.
    Riboli E. (1991): European Prospective Study on Nutrition, Cancer, and Health. Report of the pilot study, phase II January 1990-February 1991 and Protocol of the Prospective Study - International Agency for Research on Cancer, Lyon, March 1991.Google Scholar
  36. 36.
    Rohan T.E. and Bain C.J. (1987): Diet in the epidemiology of breast cancer - Epidemiol. Rev. 9: 120–145.Google Scholar
  37. 37.
    Rose G., Blackburn H., Gillum R. and Prineas R. (1982): Cardiovascular Survey Methods - pp. 82–85 WHO, Geneva.Google Scholar
  38. 38.
    Rose G., Blackburn H., Gillum R. and Prineas R. (1982): Cardiovascular Survey Methods - pp.85–88 WHO, Geneva.Google Scholar
  39. 39.
    Rutqvist L.E., Miller A.B., Andersson L., Hakama M., Hakulinen T., Sigfusson B.F. and Tabar L. (1990): Reduced breast cancer mortality with mammography screening. An assessment of currently available data. Int. J. Cancer (suppl) 5: 76–84.Google Scholar
  40. 40.
    Sempos C.T., Johnson N.E., Smith E.L. and Gilligan C. (1985): Effects of intraindividual and interindividual variation in repeated dietary records. Am. J. Epidemiol. 121: 120–130.Google Scholar
  41. 41.
    Thomas D.B. and Chu J. (1986): Nutritional and endocrine factors in reproductive organ cancer: Opportunities for primary prevention - J. Chronic Dis. 12: 1031–1050.Google Scholar
  42. 42.
    Trevisan M., Ferro-Luzzi A., Krogh Y., et al. Questionario alimentare semiquantitativo sviluppato per indagini epidemiologiche in Italia. In: Panico S. et al. (eds). La Malattia Cardiovascolare Arteriosclerotica nella Donna: Una nuova generazione di study epidemiologici - Ann. Ist. Sup. San. 1992 (in press).Google Scholar
  43. 43.
    Uemura K. and Pisa Z. (1988): Trends in cardiovascular diseases mortality in industrialized countries since 1950. World Health Statistics -Quarterly 41: 155–178.Google Scholar
  44. 44.
    Verdecchia A., Capocaccia R., Egidi V. and Golini A. (1989): A method for the estimation of chronic disease morbidity and trends from mortality data -Stat. Medic. 8: 201–216.Google Scholar
  45. 45.
    Wahrendorf J. (1989): Dietary fat, dietary cholesterol and obesity as risk factors for colorectal cancer, kidney cancer and other tumours. In: Miller A.B. (ed.). diet and the aetiology of cancer. Monographs/European School of Oncology - pp.13–20 Springer-Verlag, Berlin Heidelberg New York.Google Scholar
  46. 46.
    Wahrendorf J., Boeing H., Heinemann L., Kulesza W., Rywik S.L., Schroll M., Sznajd J. and Thiel C. (1989): Results from a comparative dietary assessment in Europe: II Feasibility of pooling individual-base dietary data between countries - Eur. J. Clin. Nutr. 43: 379–390.Google Scholar
  47. 47.
    Winn D.M., Reichman M.E. and Gunter E. (1990): Epidemiologic issues in the design and use of biologic specimen banks. Epidemiol. Rev. 12: 56–70.Google Scholar
  48. 48.
    Zanetti R. and Crosignani P. (1991): 11 Cancro in Italia. I dati dei Registri Tumori Italiani 1983–1987: incidenza e mortalità per tumori maligni. Lega Italiana per la Lotta contro i Tumori - Roma (in press)Google Scholar

Copyright information

© Gustav Fischer 1992

Authors and Affiliations

  • S. Panico
    • 1
  • R. Dello Iacovo
    • 1
  • E. Celentano
    • 2
  • R. Galasso
    • 2
  • P. Muti
    • 3
  • M. Salvatore
    • 2
  • M. Mancini
    • 1
  1. 1.Institute of Internal Medicine and Metabolic Diseases2nd Medical School University of NaplesNaplesItaly
  2. 2.Scientific DirectionNational Cancer Institute at NaplesItaly
  3. 3.Division of EpidemiologyNational Cancer Institute at MilanItaly

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