European Journal of Epidemiology

, Volume 22, Issue 11, pp 747–754

Forty-year coronary mortality trends and changes in major risk factors in the first 10 years of follow-up in the seven countries study

  • Alessandro Menotti
  • Mariapaola Lanti
  • Daan Kromhout
  • Henry Blackburn
  • Aulikki Nissinen
  • Anastasios Dontas
  • Antony Kafatos
  • Srecko Nedeljkovic
  • Hisashi Adachi
Cardiovascular Disease

Abstract

Time trends in coronary heart disease (CHD) mortality during a 40-year follow-up were studied in the Seven Countries Study. Thirteen cohorts of men aged 40–59 at entry were enrolled in seven countries (USA, Finland, the Netherlands, Italy, Serbia, Greece and Japan) for a total of 10,628 subjects. Cardiovascular risk factors were measured at entry and at the 10-year follow-up examination and coronary heart disease mortality data collected during 40 years. During the 40-year follow-up, the hazard rate of the Weibull parametric distribution (annual conditional risk of death) for CHD mortality tended to slightly decline in the US, Finnish, Dutch and Japanese cohorts, moderately increased in Italy and exponentially increased in cohorts of Serbia and Greece. A strong positive association was found between the shape of the hazard curve, describing the acceleration of the hazard, and a score of population mean risk factor changes (serum cholesterol, systolic blood pressure and smoking prevalence) observed during the first 10 years of follow-up, with a correlation coefficient of 0.91 between the two indicators. The countries with a relative decline in the annual hazard function were the same where, during the same historical period, large decreases in official death rate from CHD were recorded, and viceversa. The acceleration in mortality risk for CHD mortality in different countries, described by the shape of the Weibull distribution, is related to changes in mean levels of major coronary risk factors.

Keywords

Coronary heart disease Risk factors Time trends 

Abbreviations

CHD

Coronary heart disease

SCS

Seven Countries Study

WHO

World Health Organization

WHO-ICD

World Health Organization International Classification of Diseases and Cause of Death

References

  1. 1.
    Keys A (editor) 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. Coronary heart disease in seven countries. Circulation 1970; 41 Suppl 1:1–211.Google Scholar
  2. 2.
    Keys A (editor) Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Karvonen MJ, Kimura N, Menotti A, Mohacek I, Nedeljkvic S, Puddu V, Punsar S, Taylor HL, Van Buchem FSP. Seven Countries Study. A multivariate analysis of death and coronary heart disease. Cambridge Mass: Harvard Univ Press. 1980:1–381.Google Scholar
  3. 3.
    Menotti A, Keys A, Kromhout D, Blackburn H, Aravanis C, Bloemberg B, Buzina R, Dontas A, Fidanza F, Giampaoli S, Karvonen M, Lanti M, Pekkanen J, Punsar S, Seccareccia F, Toshima H. Inter-cohort differences in coronary heart disease mortality in the 25-year follow-up of the Seven Countries Study. Eur J Epidemiol 1993;9:527–36.PubMedCrossRefGoogle Scholar
  4. 4.
    Menotti A, Puddu PE, Lanti M, Kromhout D, Blackburn H, Nissinen A. Twenty-five-year coronary mortality trends in the seven countries study using the accelerated failure time model. Eur J Epidemiol 2003;18:113–22.PubMedCrossRefGoogle Scholar
  5. 5.
    Rose GA, Blackburn H. Cardiovascular survey methods. Geneva: World Health Organization; 1968, 1–188.Google Scholar
  6. 6.
    Anderson JT, Keys A. Cholesterol in serum and lipoprotein fractions: its measurement and stability. Clin Chem 1956;2:145–59.PubMedGoogle Scholar
  7. 7.
    World Health Organization. International classification of diseases and causes of death. 8th Revision. Geneva: World Health Organization; 1965.Google Scholar
  8. 8.
    Afifi AA, Clark V. Computer-aided multivariate analysis. 2nd ed. New York: Van Nostrand – Reinhold co; 1990.Google Scholar
  9. 9.
    Cox DR. Regression models and life tables. JR Stat Soc 1972;B43:187–220.Google Scholar
  10. 10.
    Nedeljkovic S, Menotti A, Keys A, Ostojic MC, Grujic MZ, Kromhout D, Stojanovic G. Coronary heart disease in three cohorts of men in Serbia followed-up for 25 years as a part of the Seven Countires Study. Kardiologija 1992;1–2:35–44.Google Scholar
  11. 11.
    Nedeljkovic S, Ostojic MC, Grujic MZ, Josipovic V, Keys A, Menotti A, Seccareccia F, Lanti M, Kromhout D. Coronary heart disease in 25 years. The experience in the three Serbian cohorts of the Seven Countries Study. Acta Cardiol 1993;48:11–24.PubMedGoogle Scholar
  12. 12.
    Kromhout D, Nedeljkovic S, Grujic MZ, Ostojic MG, Keys A, Menotti A, Katan MB, Van Oostrom MA, Bloemberg BPM. Changes in major risk factors for cardiovascular diseases over 25 years in the Serbian cohorts of the Seven Countries Study. Int J Epidemiol 1994;23:5–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Nedeljkovic S, Ostojic M, Vukotic MR, Grujic MZ. Recent trends in cardiovascular disease and risk factors in the Seven Countries Study: Yugoslavia. In: Toshima H, Koga Y, Blackburn H, Keys A, editors. Lessons for science from the Seven Countries Study. A 35-year collaborative experience in cardiovascular diseases epidemiology. Tokyo: Springer Verlag; 1994. p. 75–91.Google Scholar
  14. 14.
    Dontas AS. Recent trends in cardiovascular disease and risk factors in the Seven Countries Study: Greece. In: Toshima H, Koga Y, Blackburn H, Keys A, editors. Lessons for science from the Seven Countries Study. A 35-year collaborative experience in cardiovascular diseases epidemiology. Tokyo: Springer Verlag; 1994. p. 93–111.Google Scholar
  15. 15.
    Kromhout D, Menotti A, Blackburn H. Prevention of coronary heart disease. Diet, lifestyle, risk factors in the Seven Countries Study. Norwell Ma USA, Dordrecht NL: Kluwer;2002. 1–267.Google Scholar
  16. 16.
    Lanti M, Menotti A, Nedeljkovic S, Nissinen A, Kafatos A, Kromhout D. Long-term trends in major cardiovascular risk factors in cohorts of aging men in the European cohorts of the Seven Countries Study. Aging Clin Exp Res 2005;17:306–15.PubMedGoogle Scholar
  17. 17.
    Menotti A, Blackburn H, Kromhout D, Nissinen A, Fidanza F, Giampaoli S, Buzina R, Mohacek I, Nedeljkovic S, Aravanis C, Toshima H. Changes in population cholesterol levels and coronary heart disease deaths in seven countries. Eur Heart J 1997;18:566–71.PubMedGoogle Scholar
  18. 18.
    Menotti A, Keys A, Blackburn H, Karvonen M, Punsar S, Nissinen A, Pekkanen J, Kromhout D, Giampaoli S, Seccareccia F, Fidanza F, Nedeljkovic S, Aravanis C, Dontas A, Toshima H. Blood pressure changes as predictors of future mortality in the Seven Countries Study. J Human Hypert 1991;5:137–44.Google Scholar
  19. 19.
    Menotti A, Jacobs DR, Blackburn H, Kromhout D, Nissinen A, Nedeljkovic S, Buzina R, Mohacek I, Seccareccia F, Giampaoli S, Dontas S, Aravanis C, Toshima H. Twenty-five-year prediction of stroke deaths in the Seven Countries Study. The role of blood pressure and its changes. Stroke 1996;27:381–87.PubMedGoogle Scholar
  20. 20.
    Menotti A, Lanti M, Kafatos A, Nissinen A, Dontas A, Nedeljkovic S, Kromhout D. The role of a baseline casual blood pressure measurement and of blood pressure changes in middle age in prediction of cardiovascular and all-cause mortality occurring late in life : a cross-cultural comparison among the European cohorts of the Seven Countries Sudy. J Hypertens 2004;22:1683–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Monica, Monograph and Multimedia sources. Edited by Hugh Tunstall-Pedoe for the WHO Monica Project. Geneva, World Health Organization, 2003.Google Scholar
  22. 22.
    Thom T, Epstein FH, Feldman JJ, Laeverton PE, Wolz M. Total mortality and mortality from heart disease, cancer and stroke from 1950 to 1987 in 27 countries. NIH, NHLBI, NIH Publication No.92-3088. Bethesda, MD: 1992.Google Scholar
  23. 23.
    Epidemiology and prevention of cardiovascular diseases. NIH, NHLBI: Bethesda, MD. 1994.Google Scholar
  24. 24.
    Sans S, Kesteloot H, Kromhout D, on behalf of the Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. The burden of cardiovascular diseases mortality in Europe. Eur Heart J 1997; 18:1231–48.Google Scholar
  25. 25.
    Toshima H, Koga Y, Blackburn H, Keys A (editors) Lessons for science from the Seven Countries Study. A 35-year collaborative experience in cardiovascular diseases Epidemiology. Tokyo: Springer Verlag; 1994.Google Scholar
  26. 26.
    Kesteloot H, Sans S, Kromhout D. The dynamics of cardiovascular and all-cause mortality in Eastern and Western Europe between 1970 and 2000. Eur Heart J 2006;27:107–113.PubMedCrossRefGoogle Scholar
  27. 27.
    Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet 1999;353:1547–57.PubMedCrossRefGoogle Scholar
  28. 28.
    Kuulamsaa K, Tunstall-Pedoe H, Dobson A, Fortmann S, Sans S, Tolonen H, Evans A, Ferrario M, Tuomilehto J. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet 2000;355:675–87.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2007

Authors and Affiliations

  • Alessandro Menotti
    • 1
  • Mariapaola Lanti
    • 1
  • Daan Kromhout
    • 2
  • Henry Blackburn
    • 3
  • Aulikki Nissinen
    • 4
  • Anastasios Dontas
    • 5
  • Antony Kafatos
    • 6
  • Srecko Nedeljkovic
    • 7
  • Hisashi Adachi
    • 8
  1. 1.Association for Cardiac Research – Associazione per la Ricerca CardiologicaRomeItaly
  2. 2.Department of Human NutritionUniversity of WageningenWageningenThe Netherlands
  3. 3.Department of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisUSA
  4. 4.Department of Health Promotion and Chronic Diseases PreventionNational Institute of Public HealthHelsinkiFinland
  5. 5.Athens Home for the Aged Research CenterAthensGreece
  6. 6.Department of Preventive Medicine and Nutrition Clinic, Medical SchoolUniversity of CreteCreteGreece
  7. 7.Institute of Cardiovascular DiseasesClinical Center of SerbiaBelgradeSerbia
  8. 8.3rd Department of Internal MedicineKurume University School of MedicineKurumeJapan

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