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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.. Source

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. Source

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. Source

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. Source

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. Source

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