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Cirillo M.,University of Salerno | Mancini M.,University of Naples Federico II | Menotti A.,Association for Cardiac Research | Zanchetti A.,University of Milan
International Journal of Epidemiology | Year: 2014

The Gubbio Study is a prospective epidemiological study on the population residing in the city of Gubbio, Italy. Original objectives of the study were the control of hypertension and the role of cellular electrolyte handling in hypertension. Other objectives were added during the 30-year activity of the study. The original target cohort consists of individuals aged ≥ 5 years residing within the medieval walls of the city. To complete family genealogies, individuals residing outside the city were also included. Three active screenings (exams) were conducted. A total of 5376 individuals (response rate 92%) participated in Exam 1 which was performed in 1983-86. Follow-up exams were completed between 1989-92 and 2001-2007. Data categories included demographics, personal and family medical history, lifestyle habits, education, type of work, anthropometry, blood pressure, pulse rate, blood biochemistry, urine biochemistry and special investigations on cellular electrolyte handling. Electrocardiogram, echocardiogram, 24-h ambulatory blood pressure and uroflowmetry were performed in selected subgroups defined by age and/or sex. Data about hospitalizations, mortality and causes of death were collected starting from completion of Exam 1. The study shared the data with other studies. © The Author 2013; all rights reserved.

Menotti A.,Association for Cardiac Research | Puddu P.E.,University of Rome La Sapienza | Maiani G.,Centro Of Ricerca Per Gli Alimenti E La Nutrizione | Catasta G.,Centro Of Ricerca Per Gli Alimenti E La Nutrizione
International Journal of Cardiology | Year: 2016

Objectives To relate major causes of death with lifestyle habits in an almost extinct male middle-aged population. Material and methods A 40-59 aged male population of 1712 subjects was examined and followed-up for 50 years. Baseline smoking habits, working physical activity and dietary habits were related to 50 years mortality subdivided into 12 simple and 3 composite causes of death by Cox proportional hazard models. Duration of survival was related to the same characteristics by a multiple linear regression model. Results Death rate in 50 years was of 97.5%. Out of 12 simple groups of causes of death, 6 were related to smoking habits, 3 to physical activity and 4 to dietary habits. Among composite groups of causes of death, hazard ratios (and their 95% confidence limits) of never smokers versus smokers were 0.68 (0.57-0.81) for major cardiovascular diseases; 0.65 (0.52-0.81) for all cancers; and 0.72 (0.64-0.81) for all-cause deaths. Hazard ratios of vigorous physical activity at work versus sedentary physical activity were 0.63 (0.49-0.80) for major cardiovascular diseases; 1.01 (0.72-1.41) for all cancers; and 0.76 (0.64-0.90) for all-cause deaths. Hazard ratios of Mediterranean Diet versus non-Mediterranean Diet were 0.68 (0.54-0.86) for major cardiovascular diseases; 0.54 (0.40-0.73) for all cancers; and 0.67 (0.57-0.78) for all-cause deaths. Expectancy of life was 12 years longer for men with the 3 best behaviors than for those with the 3 worst behaviors. Conclusions Some lifestyle habits are strongly related to lifetime mortality. © 2016 Elsevier Ireland Ltd. All rights reserved.

Kromhout D.,Wageningen University | Kromhout D.,University of Minnesota | Geleijnse J.M.,Wageningen University | Menotti A.,Association for Cardiac Research | Jacobs Jr. D.R.,University of Minnesota
British Journal of Nutrition | Year: 2011

A recent meta-analysis of prospective cohort studies has not found an association between dietary saturated fat intake and CHD incidence. This funnelled the discussion about the importance of the recommendation to lower the intake of saturated fat for the prevention of CHD. At the same time a document of the European Food Safety Authority has suggested that specific quantitative recommendations are not needed for individual fatty acids but that more general statements can suffice. In this review, we discuss methodological aspects of the absence of association between SFA intake and CHD incidence in prospective cohort studies. We also summarise the results of the controlled dietary experiments on blood lipids and on CHD incidence in which saturated fat was replaced by either cis-unsaturated fat or carbohydrates. Finally, we propose a nutritionally adequate diet with an optimal fatty acid composition for the prevention of CHD in the context of dietary patterns. Such diets are characterised by a low intake of saturated fat, and as low as possible intake of trans-fat and fulfil the requirements for the intake of n-6 and n-3 fatty acids. No recommendation is needed for the intake of cis-MUFA. © 2011 The Authors.

Menotti A.,Association for Cardiac Research | Alberti-Fidanza A.,University of Rome Tor Vergata | Fidanza F.,University of Rome Tor Vergata | Lanti M.,Association for Cardiac Research | Fruttini D.,University of Perugia
Public Health Nutrition | Year: 2012

Objective The purpose was to examine the role of dietary patterns derived from factor analysis and their association with health and disease. Design Longitudinal population study, with measurement of diet (dietary history method), cardiovascular risk factors and a follow-up of 20 years for CHD incidence and 40 years for mortality. Setting Two population samples in rural villages in northern and central Italy. Subjects Men (n 1221) aged 45-64 years were examined and followed up. Results One of the factors identified with factor analysis, run on seventeen food groups, was converted into a factor score (Factor 2 score) and used as a possible predictor of morbid and fatal events. High values of Factor 2 score were characterized by higher consumption of bread, cereals (pasta), potatoes, vegetables, fish and oil and by lower consumption of milk, sugar, fruit and alcoholic beverages. In multivariate analysis, Factor 2 score (mean 0·0061; sd 1·3750) was inversely and significantly associated (hazard ratio for a 1 sd increase; 95% CI) with 20-year CHD incidence (0·88; 0·73, 0·96) and 40-year mortality from CHD (0·79; 0·66, 0·95), CVD (0·87; 0·78, 0·96), cancer (0·84; 0·74, 0·96) and all causes (0·89; 0·83, 0·96), after adjustment for five other risk factors. Men in quintile 5 of Factor 2 score had a 4·1 years longer life expectancy compared with men in quintile 1. Conclusions A dietary pattern derived from factor analysis, and resembling the characteristics of the Mediterranean diet, was protective for the occurrence of various morbid and fatal events during 40 years of follow-up. © 2012 The Authors.

Menotti A.,Association for Cardiac Research | Puddu P.E.,University of Rome La Sapienza
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2015

The Seven Countries Study of Cardiovascular Diseases was started at the end of the 1950s and it continues to be run after >50 years. It enrolled, at entry, 16 population cohorts in eight nations of seven countries for a total of 12,763 middle-aged men. It was the prototype of epidemiological studies seeking cultural contrasts and the first to compare cardiovascular disease (CVD) rates related to diet differences. The study has shown that populations suffer widely different incidence and mortality rates from coronary heart disease (CHD) as well as from other CVDs and overall mortality. Higher rates were found in North America and northern Europe, and lower rates in southern Europe - Mediterranean countries - and Japan. These differences in CHD rates were strongly associated with different levels of saturated fat consumption and average serum cholesterol levels, with lowest rates in Greece and Japan where the total fat intake was very different. The cohorts were also different in dietary patterns defined by the ratio of calories derived from plant foods and fish on the one hand and calories derived from animal foods and sugar on the other. These findings pointed to the so-called Mediterranean diet, which is characterized by large values of that plant/animal ratio, a pattern associated with lower incidence and mortality from CHD and also with the lowest death rates and the greatest survival rates. More recent studies have refined these concepts and documented on a larger scale the virtues of these eating habits. © 2014 Elsevier B.V..

Puddu P.E.,University of Rome La Sapienza | Piras P.,University of Rome La Sapienza | Menotti A.,Association for Cardiac Research
International Journal of Cardiology | Year: 2016

Objectives To study coronary heart disease (CHD) incidence versus other cause of death using the cumulative incidence function and the competing risks procedures to disentangle the differential role of risk factors for different end-points. Material and methods We compared standard Cox and Fine-Gray models among 1677 middle aged men of an Italian population study of cardiovascular diseases that reached 50 years of follow-up with the quasi extinction of the population. The incidence of either fatal or non-fatal cases in 50 years was used as primary event, while deaths from any other cause, mutually exclusive from the primary events, were considered as secondary events. We considered 10 selected risk factors. Results The main result was that cholesterol was significantly and positively related to incidence of CHD contrasted with deaths from any other cause. On the other hand, when the primary events were deaths from any other cause and the competing events were CHD, cholesterol was inversely and age positively related. This outcome did not exclude the predictive role of other risk factors, such as age, cigarettes, arm circumference (protective), systolic blood pressure, vital capacity (protective), cholesterol, corneal arcus and diabetes, documented by the Cox model, that had common roles for both end-points. Conclusions Fine-Gray model, initially proposed to handle adequately cumulative incidence function may thus prevent overestimation of risks related to the Kaplan-Meier based methods such as Cox model and identify the specific risk factors for defined end-points. © 2015 Elsevier Ireland Ltd. All rights reserved.

Menotti A.,Association for Cardiac Research | Puddu P.E.,University of Rome La Sapienza | Lanti M.,Association for Cardiac Research | Maiani G.,Instituto Nazionale Of Ricerca Per Gli Alimenti E La Nutrizione | And 2 more authors.
Journal of Nutrition, Health and Aging | Year: 2014

Objectives: Three lifestyle factors were investigated in a population study to explore their relationships with a long-term mortality. Material and Methods: In a cohort of 1564 men aged 45-64 and examined in 1965 within the Italian Rural Areas of the Seven Countries Study, smoking habits, physical activity at work and eating habits (as derived from factor analysis) were determined. During the follow-up 693 men died in 20 years and 1441 in 40 years. Results: In Cox proportional hazards models men smoking cigarettes (versus never smokers), those having a sedentary activity (versus the very active) and those following the Diet Score 1, indexing an unhealthy Diet (versus men with a Diet close to the healthy Mediterranean style) had highly significant hazards ratios (HR) in relations with 20- and 40-year mortality from all causes, coronary heart disease (CHD), cardiovascular disease (CVD) and cancer. HR for all causes in 40 years were 1.44 (95% confidence intervals, CI, 1.27 and 1.64) for smokers, 1.43 (CI 1.23 and 1.67) for sedentary people, and 1.31 (CI 1.15 and 1.50) for men with unhealthy diet. Larger HR were found for CHD, CVD and cancers deaths. Combination of 3 unhealthy risk factors versus their absence was associated with 4.8-year life loss in the 20-year follow-up and 10.7-year in the 40-year follow-up. Conclusions: Lifestyle behavior linked to physical activity and smoking and eating habits is strongly associated with mortality and survival in middle aged men during long-term follow-up.

Menotti A.,Association for Cardiac Research | Puddu P.E.,University of Rome La Sapienza
Journal of Cardiovascular Medicine | Year: 2013

In the Seven Countries Study of Cardiovascular Diseases, 16 cohorts of middle-aged men were enrolled in eight nations of seven countries in three continents in the late 1950s and early 1960s for a total of 12763 individuals. Thirteen cohorts were located in Europe, two in Finland, one in the Netherlands, three in Italy, two in Croatia-former Yugoslavia, three in Serbia-former Yugoslavia, and two in Greece. Another cohort was enrolled in the USA and two cohorts in Japan. Baseline prevalence of coronary heart disease (CHD) was largely different across areas, as well as 10-year incidence of major CHD events and CHD mortality for periods ranging from 25 to 40 years of follow-up. Higher rates were found in Northern Europe, lower rates in Southern Europe and intermediate rates in Eastern Europe, represented by Serbia. Differences across countries were partly explained by different entry mean levels of serum cholesterol, blood pressure, consumption of saturated fatty acids and adherence to traditional dietary patterns. Forty-year trends of CHD mortality were largely explained by early changes in serum cholesterol and blood pressure levels, with large risk increases in Serbia and Greece, and the tendency to declines in Finland and the Netherlands. These trends in Seven Countries' experience are in line with those manifests in official mortality data. An attempt of interpretation is presented pointing to socio-economic evolution in the involved countries, which heavily modifies health and dietary habits and contributes to explaining these differences at population level. © 2013 Italian Federation of Cardiology.

Menotti A.,Association for Cardiac Research | Puddu P.E.,University of Rome La Sapienza
International Journal of Cardiology | Year: 2015

Objectives The relationships of four basic risk factors with 50-year incidence of coronary heart disease (CHD) and Heart Disease of Uncertain Etiology (HDUE) were investigated in a population study. Material and methods There were 1712 men aged 40-59 years in 1960 and 1677, heart disease free, were followed-up for 50 years. Incidence of first event for CHD (sudden death, fatal and non-fatal myocardial infarction, other fatal and non-fatal coronary syndromes) and HDUE (heart failure, chronic arrhythmia, blocks, "chronic CHD", hypertensive heart disease) was estimated and the relationships of four basic risk factors analyzed. Results In 50 years incidences of CHD and HDUE were respectively 26.9 and 20.6%. Cox proportional hazards models showed serum cholesterol as a strong CHD predictor (hazard ratio, HR, for 1 mmol/l difference 1.22 and confidence intervals, CI, 1.11 to 1.33), irrelevant for HDUE (HR 1.02 and CI 0.87 to 1.18). Age at entry was a stronger predictor for HDUE (HR for 5 year difference 1.65 and CI 1.46 to 1.86) than for CHD (HR 1.26 and CI 1.14 to 1.39). Systolic blood pressure and cigarette smoking had similar predictive power. The diagnosis of angina pectoris (AP) recorded at any time during the study was strongly associated with CHD but not with HDUE. A HDUE subgroup with AP had similar life-expectancy to CHD, suggesting the need to re-classify them as CHD. Conclusions Due to important differences in predictors (risk factors) and expectancy of life CHD and HDUE are probably manifestations of different etiologies. © 2015 Elsevier Ireland Ltd. All rights reserved.

Menotti A.,Association for Cardiac Research | Puddu P.E.,University of Rome La Sapienza | Maiani G.,Italian Agricultural Research Council | Catasta G.,Italian Agricultural Research Council
International Journal of Cardiology | Year: 2015

Objectives Investigate the relationship of some behavioural characteristics of a male population with lifetime incidence of heart diseases. Material and methods In the Italian Rural Areas of the Seven Countries Study of Cardiovascular Diseases, 1677 heart disease-free men aged 40-59 years were followed up during 50 years for lifetime incidence of heart disease up to the age of 90 years. They were classified as coronary heart disease (CHD) and heart diseases of uncertain etiology (HDUE). Baseline cigarette smoking habits (non-smokers and ex-smokers, moderate smokers, heavy smokers), physical activity (sedentary, moderate, vigorous) and eating habits (non-Mediterranean Diet, Prudent Diet and Mediterranean Diet) were related to incidence of heart disease. Results Incidence of CHD and HDUE up to the age of 90 years was 28.8 and 17.7%, respectively. Univariate and multivariate analyses showed strong association of behavioural characteristics with CHD incidence, but not with HDUE incidence. Cox proportional hazard rates for CHD were 1.45 (95% confidence intervals, CI: 1.11-1.90) for heavy smokers versus non-smokers; 0.67 (CI 0.50-0.89) for vigorous activity versus sedentary habits and 0.62 (CI 0.47-0.83) for Mediterranean Diet versus non-Mediterranean Diet. Combining CHD cases with HDUE cases made the predictive picture similar to that of CHD. When some basic risk factors were added to the model results remained substantially unaltered, despite the existence of some correlations of behaviours with risk factors. Conclusions Behavioural factors including cigarette smoking, physical activity and diet are strong predictors of lifetime incidence of common heart diseases even adding other traditional risk factors. © 2015 Elsevier Ireland Ltd.

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