Staff Publications

Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

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    Comparative ecologic relationships of saturated fat, sucrose, food groups, and a Mediterranean food pattern score to 50-year coronary heart disease mortality rates among 16 cohorts of the Seven Countries Study
    Kromhout, Daan ; Menotti, Alessandro ; Alberti-Fidanza, Adalberta ; Puddu, Paolo Emilio ; Hollman, Peter ; Kafatos, Anthony ; Tolonen, Hanna ; Adachi, Hisashi ; Jacobs, David R. - \ 2018
    European Journal of Clinical Nutrition 72 (2018). - ISSN 0954-3007 - p. 1103 - 1110.

    Background/objectives: We studied the ecologic relationships of food groups, macronutrients, eating patterns, and an a priori food pattern score (Mediterranean Adequacy Index: MAI) with long-term CHD mortality rates in the Seven Countries Study. Subjects/methods: Sixteen cohorts (12,763 men aged 40–59 years) were enrolled in the 1960s in seven countries (US, Finland, The Netherlands, Italy, Greece, former Yugoslavia: Croatia/Serbia, Japan). Dietary surveys were carried out at baseline and only in a subsample of each cohort. The average food consumption of each cohort was chemically analyzed for individual fatty acids and carbohydrates. Results: Ecologic correlations of diet were computed across cohorts for 50-year CHD mortality rates; 97% of men had died in cohorts with 50-year follow-up. CHD death rates ranged 6.7-fold among cohorts. At baseline, hard fat was greatest in northern Europe, olive oil in Greece, meat in the US, sweet products in northern Europe and the US, and fish in Japan. The MAI was high in Mediterranean and Japanese cohorts. The 50-year CHD mortality rates of the cohorts were closely positively ecologically correlated (r = 0.68–0.92) with average consumption of hard fat, sweet products, animal foods, saturated fat, and sucrose, but not with naturally occurring sugars. Vegetable foods, starch, and the a priori pattern MAI were inversely correlated (r = −0.59 to −0.91) with CHD mortality rates. Conclusions: Long-term CHD mortality rates had statistically significant ecologic correlations with several aspects of diet consumed in the 1960s, the traditional Mediterranean and Japanese patterns being rich in vegetable foods, and low in sweet products and animal foods.

    The strength of the multivariable associations of major risk factors predicting coronary heart disease mortality is homogeneous across different areas of the Seven Countries Study during 50-year follow-up
    Menotti, Alessandro ; Puddu, Paolo Emilio ; Adachi, Hisashi ; Kafatos, Anthony ; Tolonen, Hanna ; Kromhout, Daan - \ 2018
    Acta Cardiologica 73 (2018)2. - ISSN 0001-5385 - p. 148 - 154.
    coefficients - Coronary heart disease - hazard ratios - homogeneity - mortality - prediction - risk factors

    Objectives: To compare the magnitude of multivariable coefficients and hazard ratios of four cardiovascular risk factors across five worldwide regions of the Seven Countries Study in predicting 50-year coronary deaths. Material and methods: A total of 13 cohorts of middle-aged men at entry (40–59 years old) were enrolled in the mid-1900s from five relatively homogeneous groups of cohorts (areas): USA, Finland and Zutphen – the Netherlands, Italy and Greece, Serbia, Japan for a total of 10,368 middle-aged men. The major risk factors measured at baseline were age, number of cigarettes smoked, systolic blood pressure and serum cholesterol. Cox proportional hazards models were solved for 50-year (45 years for Serbia) deaths from coronary heart disease (CHD), and the multivariable coefficients were compared for heterogeneity. Results: The highest levels of risk factors and CHD death rates were found in Finland and Zutphen – the Netherlands and the lowest in Japan. All four risk factors were predictive for long-term CHD mortality in all regions, except serum cholesterol in Japan where the mean levels and CHD events were lowest. Tests of heterogeneity of coefficients for single risk factors in predicting CHD mortality were non-significant across the five areas. The same analyses for the first 25 years of follow-up produced similar findings. Conclusions: The strength of the multivariable associations of four major traditional CHD risk factors with long-term CHD mortality appears to be relatively homogeneous across areas, pending needed further evidence.

    Re-calibration of coronary risk prediction : An example of the Seven Countries Study
    Puddu, Paolo Emilio ; Piras, Paolo ; Kromhout, Daan ; Tolonen, Hanna ; Kafatos, Anthony ; Menotti, Alessandro - \ 2017
    Scientific Reports 7 (2017)1. - ISSN 2045-2322
    We aimed at performing a calibration and re-calibration process using six standard risk factors from Northern (NE, N = 2360) or Southern European (SE, N = 2789) middle-aged men of the Seven Countries Study, whose parameters and data were fully known, to establish whether re-calibration gave the right answer. Greenwood-Nam-D'Agostino technique as modified by Demler (GNDD) in 2015 produced chi-squared statistics using 10 deciles of observed/expected CHD mortality risk, corresponding to Hosmer-Lemeshaw chi-squared employed for multiple logistic equations whereby binary data are used. Instead of the number of events, the GNDD test uses survival probabilities of observed and predicted events. The exercise applied, in five different ways, the parameters of the NE-predictive model to SE (and vice-versa) and compared the outcome of the simulated re-calibration with the real data. Good re-calibration could be obtained only when risk factor coefficients were substituted, being similar in magnitude and not significantly different between NE-SE. In all other ways, a good re-calibration could not be obtained. This is enough to praise for an overall need of re-evaluation of most investigations that, without GNDD or another proper technique for statistically assessing the potential differences, concluded that re-calibration is a fair method and might therefore be used, with no specific caution.
    Baseline fatty acids, food groups, a diet score and 50-year all-cause mortality rates. An ecological analysis of the Seven Countries Study
    Menotti, Alessandro ; Kromhout, Daan ; Puddu, Paolo Emilio ; Alberti-Fidanza, Adalberta ; Hollman, Peter ; Kafatos, Anthony ; Tolonen, Hanna ; Adachi, Hisashi ; Jacobs, David R. - \ 2017
    Annals of medicine 49 (2017)8. - ISSN 0785-3890 - p. 718 - 727.
    50-year follow-up - all-cause mortality - fatty acids - Seven Countries Study - socio-economic status
    Objectives: This analysis deals with the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in 16 cohorts of the Seven Countries Study. Material and methods: A dietary survey was conducted at baseline in cohorts subsamples including chemical analysis of food samples representing average consumptions. Ecologic correlations of dietary variables were computed across cohorts with 50-year all-cause mortality rates, where 97% of men had died. Results: There was a 12-year average age at death population difference between extreme cohorts. In the 1960s the average population intake of saturated (S) and trans (T) fatty acids and hard fats was high in the northern European cohorts while monounsaturated (M), polyunsaturated (P) fatty acids and vegetable oils were high in the Mediterranean areas and total fat was low in Japan. The 50-year all-cause mortality rates correlated (r= −0.51 to −0.64) ecologically inversely with the ratios M/S, (M + P)/(S + T) and vegetable foods and the ratio hard fats/vegetable oils. Adjustment for high socio-economic status strengthened (r= −0.62 to −0.77) these associations including MAI diet score. Conclusion: The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets.KEY MESSAGESWe aimed at studying the ecologic relationships of dietary fatty acids, food groups and the Mediterranean Adequacy Index (MAI, derived from 15 food groups) with 50-year all-cause mortality rates in the Seven Countries Study.The 50-year all-cause mortality rates correlated (r = −0.51 to −0.64) ecologically inversely with the ratios M/S [monounsaturated (M) + polyunsaturated (P)]/[saturated (S) + trans (T)] fatty acids and vegetable foods and the ratio hard fats/vegetable oils. After adjustment for high socio-economic status, associations with the ratios strengthened (r = −0.62 to −0.77) including also the MAI diet score.The protective fatty acids and vegetable oils are indicators of the low risk traditional Mediterranean style diets.
    Ten-year blood pressure trajectories, cardiovascular mortality and life years lost in two extinction cohorts
    Tielemans, S.M.A.J. ; Geleijnse, J.M. ; Menotti, A. ; Boshuizen, H.C. ; Soedamah-Muthu, S.S. ; Jacobs, David R. ; Blackburn, H. ; Kromhout, D. - \ 2015
    European Journal of Epidemiology 2015 (2015). - ISSN 0393-2990 - p. 728 - 728.
    Ten-Year Blood Pressure Trajectories, Cardiovascular Mortality, and Life Years Lost in 2 Extinction Cohorts: the Minnesota Business and Professional Men Study and the Zutphen Study
    Tielemans, S.M.A.J. ; Geleijnse, J.M. ; Menotti, A. ; Boshuizen, H.C. ; Soedamah-Muthu, S.S. ; Jacobs, D.R. ; Blackburn, H. ; Kromhout, D. - \ 2015
    Journal of the American Heart Association 4 (2015). - ISSN 2047-9980 - 12 p.
    follow-up - disease - risk - age - adulthood
    Background Blood pressure (BP) trajectories derived from measurements repeated over years have low measurement error and may improve cardiovascular disease prediction compared to single, average, and usual BP (single BP adjusted for regression dilution). We characterized 10-year BP trajectories and examined their association with cardiovascular mortality, all-cause mortality, and life years lost. Methods and Results Data from 2 prospective and nearly extinct cohorts of middle-aged men—the Minnesota Business and Professional Men Study (n=261) and the Zutphen Study (n=632)—were used. BP was measured annually during 1947–1957 in Minnesota and 1960–1970 in Zutphen. BP trajectories were identified by latent mixture modeling. Cox proportional hazards and linear regression models examined BP trajectories with cardiovascular mortality, all-cause mortality, and life years lost. Associations were adjusted for age, serum cholesterol, smoking, and diabetes mellitus. Mean initial age was about 50 years in both cohorts. After 10 years of BP measurements, men were followed until death on average 20 years later. All Minnesota men and 98% of Zutphen men died. Four BP trajectories were identified, in which mean systolic BP increased by 5 to 49 mm Hg in Minnesota and 5 to 20 mm Hg in Zutphen between age 50 and 60. The third systolic BP trajectories were associated with 2 to 4 times higher cardiovascular mortality risk, 2 times higher all-cause mortality risk, and 4 to 8 life years lost, compared to the first trajectory. Conclusions Ten-year BP trajectories were the strongest predictors, among different BP measures, of cardiovascular mortality, all-cause mortality, and life years lost in Minnesota. However, average BP was the strongest predictor in Zutphen.
    AbstractP044: Ten-Year Blood Pressure Trajectories and Long-Term Risk of Cardiovascular Mortality: The Minnesota Business and Professional Men Study
    Tielemans, S.M.A.J. ; Geleijnse, J.M. ; Boshuizen, H.C. ; Soedamah-Muthu, S.S. ; Menotti, A. ; Jacobs, D.R. ; Blackburn, H. ; Kromhout, D. - \ 2014
    Circulation 129 (2014)S1. - ISSN 0009-7322
    Introduction: We characterised 10[[Unable to Display Character: ‑]]year trajectories of annual blood pressure (BP) measurements and studied the added value on long-term cardiovascular disease (CVD) mortality in comparison to a single baseline BP measurement. Methods: This study is based on data from 266 men, aged 45 to 55 years, who participated in the Minnesota Business and Professional Men Study. BP was measured annually between 1947[[Unable to Display Character: ‑]]1957, a time when only very high levels of BP were treated. Men who did not die before 1957 and did not have a history of myocardial infarction or stroke were included. We identified BP trajectories by means of finite mixture group-based trajectory modelling (PROC TRAJ in SAS). For each individual, time to death was defined as the difference in years between 1957 and year of death (the last man died in 2002). Cox proportional hazards analysis was used to examine BP trajectories in relation to CVD mortality. Results: All 266 men died and 142 (53.4%) from CVD, with mean (± sd) time to death 21±10 years. We identified four systolic BP trajectories with baseline mean systolic BP levels ranging from 112 (SBP1) to 165 (SBP4) mmHg. This difference of 53 mmHg in baseline systolic BP level was associated with a hazard ratio (HR) of 2.4 (95% CI: 1.5-3.8) for CVD mortality. From age 45 to 65, mean systolic BP levels of the four trajectories (Figure 1A) increased from 0.4 to 2.1 mmHg/year for SBP1 to SBP4. For systolic BP trajectories, the HR of CVD mortality increased from 1.6 (SBP2) to 4.2 (SBP4), compared to men in SBP1 (Figure 1A). A similar pattern was observed for diastolic BP (Figure 1B). Conclusion: In this population of middle[[Unable to Display Character: ‑]]aged US men, the increase in BP was strongest in those with the highest BP levels. Trajectories of BP predicted CVD mortality much better than a single BP measurement.
    Ten-Year Blood Pressure Trajectories and Long-Term Risk of Cardiovascular Mortality: The Minnesota Business and Professional Men Study
    Tielemans, S.M.A.J. ; Geleijnse, J.M. ; Boshuizen, H.C. ; Soedamah-Muthu, S.S. ; Menotti, A. ; Jacobs, D.R. ; Blackburn, H. ; Kromhout, D. - \ 2014
    Circulation 129 (2014). - ISSN 0009-7322
    Introduction: We characterised 10[[Unable to Display Character: ‑]]year trajectories of annual blood pressure (BP) measurements and studied the added value on long-term cardiovascular disease (CVD) mortality in comparison to a single baseline BP measurement. Methods: This study is based on data from 266 men, aged 45 to 55 years, who participated in the Minnesota Business and Professional Men Study. BP was measured annually between 1947[[Unable to Display Character: ‑]]1957, a time when only very high levels of BP were treated. Men who did not die before 1957 and did not have a history of myocardial infarction or stroke were included. We identified BP trajectories by means of finite mixture group-based trajectory modelling (PROC TRAJ in SAS). For each individual, time to death was defined as the difference in years between 1957 and year of death (the last man died in 2002). Cox proportional hazards analysis was used to examine BP trajectories in relation to CVD mortality. Results: All 266 men died and 142 (53.4%) from CVD, with mean (± sd) time to death 21±10 years. We identified four systolic BP trajectories with baseline mean systolic BP levels ranging from 112 (SBP1) to 165 (SBP4) mmHg. This difference of 53 mmHg in baseline systolic BP level was associated with a hazard ratio (HR) of 2.4 (95% CI: 1.5-3.8) for CVD mortality. From age 45 to 65, mean systolic BP levels of the four trajectories (Figure 1A) increased from 0.4 to 2.1 mmHg/year for SBP1 to SBP4. For systolic BP trajectories, the HR of CVD mortality increased from 1.6 (SBP2) to 4.2 (SBP4), compared to men in SBP1 (Figure 1A). A similar pattern was observed for diastolic BP (Figure 1B). Conclusion: In this population of middle[[Unable to Display Character: ‑]]aged US men, the increase in BP was strongest in those with the highest BP levels. Trajectories of BP predicted CVD mortality much better than a single BP measurement
    Epidemiology of typical coronay heart disease versus heart disease of uncertain etiology (atypical) fatalities and their relationships with classic coronary risk factors
    Menotti, A. ; Puddu, P.E. ; Lanti, M. ; Kromhout, D. ; Tolonen, H. ; Parapid, B. - \ 2013
    International Journal of Cardiology 168 (2013)4. - ISSN 0167-5273 - p. 3963 - 3967.
    artery disease - myocardial lesions - total cholesterol - european cohorts - 7 countries - mortality - failure - serum - criteria - sudden
    Objectives: The relationships were explored of some cardiovascular risk factors to typical (TYP) and atypical (ATYP) fatal coronary events (CHD). Material and methods: Thirteen cohorts of 40-59 year-old men of the Seven Countries Study were followed-up for 40 years (N = 9704 heart disease free subjects). Fatal TYP-CHD were classified when manifested as myocardial infarction, other acute coronary syndromes, angina pectoris and sudden death; and as ATYP-CHD when manifested only as heart failure or arrhythmia in the absence of other clear etiologies. Death rates were computed for single countries separately for TYP and ATYP and for different lengths of follow-up. Cox models included: age, smoking habits, systolic blood pressure (SBP), serum cholesterol (CHOL), forced expiratory volume in 3/4 sec (FEV) and diabetes. Results: TYP-CHD was more common in North American and Northern European countries, while ATYP-CHD were more common in Southern and Eastern Europe. Age at death was 5 years greater for ATYP-CHD than for TYP-CHD. Cox models in the pool of 13 cohorts showed that coefficient for age was significantly larger for ATYP-CHD (hazard ratio, HR: 2.36; confidence intervals CI: 2.18 - 2.26) versus TYP-CHD (HR 1.50, CI 1.43-1.58) while coefficients for CHOL was larger and significant for TYP-CHD (HR 1.29, CI 1.22-1.35) but not for ATYP-CHD (HR 0.93, CI 0.85-1.03). SBP, smoking habits, FEV and diabetes all predicted both conditions almost equally. Conclusion: The different relationships of CHOL and age with the two types of fatal CHD suggest that the two groups of manifestations may belong to different diseases. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
    Influence of calendar period on the association between BMI and coronary heart disease: a meta-analysis of 31 cohorts : Review
    Hollander, E.L. de; Bogers, R.P. ; Boshuizen, H.C. ; Rosengren, A. ; Shipley, M.J. ; Knekt, P. ; Ducimetiere, P. ; Menotti, A. ; Groot, C.P.G.M. de; Bemelmans, W.J.E. - \ 2013
    Obesity 21 (2013)5. - ISSN 1930-7381 - p. 865 - 880.
    body-mass index - all-cause mortality - cardiovascular risk-factors - monica project populations - life-style factors - follow-up - physical-activity - blood-pressure - western-australia - abdominal obesity
    Objective: The association between obesity and coronary heart disease (CHD) may have changed over time, for example due to improved pharmacological treatment of CHD risk factors. This meta-analysis of 31 prospective cohort studies explores the influence of calendar period on CHD risk associated with body mass index (BMI). Design and Methods: The relative risks (RRs) of CHD for a five-BMI-unit increment and BMI categories were pooled by means of random effects models. Meta-regression analysis was used to examine the influence of calendar period (>1985 v =1985) in univariate and multivariate analyses (including mean population age as a covariate). Results: The age, sex, and smoking adjusted RR (95% confidence intervals) of CHD for a five-BMI-unit increment was 1.28(1.22:1.34). For underweight, overweight and obesity, the RRs (compared to normal weight) were 1.11(0.91:1.36), 1.31(1.22:1.41), and 1.78(1.55:2.04), respectively. The univariate analysis indicated 31% (95%CI: -56:0) lower RR of CHD associated with a five-BMI-unit increment and a 51% (95%CI: -78: -14)) lower RR associated with obesity in studies starting after 1985 (n = 15 and 10, respectively) compared to studies starting in or before 1985 (n = 16 and 10). However, in the multivariate analysis, only mean population age was independently associated with the RRs for a five-BMI-unit increment and obesity (-29(95%CI: -55: -5)) and -31(95%CI: -66:3), respectively) per 10-year increment in mean age). Conclusion: This study provides no consistent evidence for a difference in the association between BMI and CHD by calendar period. The mean population age seems to be the most important factor that modifies the association between the risk of CHD and BMI, in which the RR decreases with increasing age.
    The confusion about dietary fatty acids recommendations for CHD prevention
    Kromhout, D. ; Geleijnse, J.M. ; Menotti, A. ; Jacobs, D.R. - \ 2011
    The British journal of nutrition 106 (2011)5. - ISSN 0007-1145 - p. 627 - 632.
    coronary-heart-disease - cardiovascular-disease - serum-cholesterol - saturated fat - controlled-trials - risk-factors - metaanalysis - carbohydrate - association - cohort
    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
    Influence of calendar period on the association between body mass index and coronary heart disease in an adult population: a meta-analysis of 31 cohorts
    Hollander, E.L. de; Bogers, R.P. ; Boshuizen, H.C. ; Rosengren, A. ; Shipley, M.J. ; Knekt, P. ; Ducimetière, P. ; Menotti, A. ; Groot, C.P.G.M. de; Bemelmans, W.J.E. - \ 2010
    In: Book of Abstracts of the 3rd European Public Health Conference. - - p. 109 - 109.
    Respiratory function and other biological risk factors for completed suicide: 40 years of follow-up of European cohorts of the Seven Countries Study
    Giltay, E.J. ; Zitman, F.G. ; Menotti, A. ; Nissinen, A. ; Jacobs, D.R. ; Adachi, H. ; Kafatos, A. ; Kromhout, D. - \ 2010
    Journal of Affective Disorders 120 (2010)1-3. - ISSN 0165-0327 - p. 249 - 253.
    body-mass index - serum-cholesterol - united-states - lung-function - men - association - mortality - height - death - ideation
    Background - Prospective cohort studies on biological risk factors of completed suicide are scarce. We aimed to test which biological risk factors independently identify subjects at increased risk of suicidal death. Methods - In the prospective cohort of the Seven Countries Study, 5,321 middle-aged men from Finland, Serbia, Italy, and Greece were included. Completed suicide (ICD-8 codes E950-959) was assessed during 40 years of follow-up. Biological cardiovascular risk factors (including forced vital capacity [FVC] and height) were tested for their role as predictors in multivariable Cox models stratified by country. Results - There were 4518 deaths during follow-up, with 64 from suicide (1.4%). In univariable models, only FVC and height were strongly inversely related with suicide. Socio-economic status and being unmarried were potential confounders. In multivariable models taking these confounders into account, both a low FVC (0.30 for top vs. lowest quartile; 95% CI: 0.12–0.76; P = 0.006 for trend) and a low FVC/height ratio (0.37 for top vs. lowest quartile; 95% CI: 0.17–0.82; P = 0.004 for trend) were strongly inversely related with completed suicide. Limitations - Information on proximal causes, such as prior suicidal ideation, emotional distress and depression, was lacking at baseline. Conclusions - Poor respiratory function in middle-aged men was an independent risk factor for completed suicide
    Cardiovascular risk factors and dementia mortality: 40 years of follow-up in the Seven Countries Study
    Alonso, A. ; Jacobs, D.R. ; Menotti, A. ; Nissinen, A. ; Dontas, A. ; Kafatos, A. ; Kromhout, D. - \ 2009
    Journal of the Neurological Sciences 280 (2009)1-2. - ISSN 0022-510X - p. 79 - 83.
    alzheimers-disease - vascular dementia - cognitive decline - blood-pressure - midlife - smoking - cholesterol - life - atherosclerosis - metaanalysis
    Previous research shows that cardiovascular risk factors in mid-adulthood could increase the risk of dementia later in life, but studies with very long follow-up are still scarce. We assessed whether cardiovascular risk factors measured in midlife were associated with dementia mortality during a 40-year follow-up. 10,211 men, aged 40-59 at baseline, from 13 cohorts of the Seven Countries Study were followed for 40 years. Information on cardiovascular risk factors was obtained at baseline from questionnaires and a physical examination. Dementia death was assigned if there was any mention of dementia on the death certificate. Associations between cardiovascular risk factors and death from dementia were estimated through Cox proportional hazards models. We identified 160 dementia deaths during the follow-up. Smoking, hypercholesterolemia, high blood pressure, low forced vital capacity and previous history of cardiovascular disease at baseline were associated with a higher risk of death from dementia in the follow-up. The hazard ratio (HR) of dementia death among heavy smokers was 1.58 (95% confidence interval (CI) 1.03, 2.43) compared to non-smokers. Similarly, the HR (95% CI) among those with systolic BP -> 160 or diastolic BP -> 95 mm Hg compared to normotensives (<140/90) was 1.55 (1.02, 2.35). Individuals with the largest forced vital capacity had a lower risk of dying of dementia (HR 0.54, 95% CI 0.30, 0.98). Finally, total serum cholesterol was directly associated with higher risk of dementia mortality (p for trend = 0.03). In men, cardiovascular risk factors in midlife are associated with increased risk of dementia death later in life
    Homogeneity in the relationship of serum cholesterol to coronary deaths across different cultures: 40-year follow-up of the Seven Countries Study
    Menotti, A. ; Lanti, M. ; Kromhout, D. ; Blackburn, H. ; Jacobs, D. ; Nissinen, A. ; Dontas, A. ; Kafatos, A. ; Nedeljkovic, S. ; Adachi, H. - \ 2008
    European Journal of Cardiovascular Prevention and Rehabilitation 15 (2008)6. - ISSN 1741-8267 - p. 719 - 725.
    heart-disease - europe - risk - prediction - mortality - project - score
    Background: The aim was to investigate whether multivariate coefficients of serum cholesterol in the prediction of coronary heart disease (CHD) deaths were similar across different cultures in a long-term follow-up. Design: Thirteen cohorts for a total of 10 157 men aged 40¿59 years at entry, enrolled in seven countries (USA, Finland, the Netherlands, Italy, Serbia, Greece, Japan) were repeatedly examined and followed up for 40 years. Methods: Serum cholesterol measured at baseline, and then on repeated occasions, was studied, using multivariate models, in relation with the occurrence of CHD deaths during a 40-year follow-up. Results: Homogeneity of multivariate serum cholesterol coefficients was found considering cholesterol levels at baseline, as average of up to three measurements during the first 10 years, as average of up to six measurements in 35 years, using the time-dependent technique with up to three measurements in 10 years, and with up to six measurement in 35 years. Conclusion: The strength of the association between serum cholesterol and CHD death seems homogeneous across different cultures characterized by different levels of serum cholesterol and different absolute risk of CHD death.
    Effects of Past and Recent Blood Pressure and Cholesterol Level on Coronary Heart Disease and Stroke Mortality, Accounting for Measurement Error - Reply ( letter to the editor
    Boshuizen, H.C. ; Lanti, M. ; Menotti, A. ; Moschandreas, J. ; Tolonen, H. ; Nissinen, A. ; Nedeljkovic, S. ; Kafatos, A. ; Kromhout, D. - \ 2008
    American Journal of Epidemiology 167 (2008)4. - ISSN 0002-9262 - p. 503 - 504.
    The authors aimed to quantify the effects of current systolic blood pressure (SBP) and serum total cholesterol on the risk of mortality in comparison with SBP or serum cholesterol 25 years previously, taking measurement error into account. The authors reanalyzed 35-year follow-up data on mortality due to coronary heart disease and stroke among subjects aged 65 years or more from nine cohorts of the Seven Countries Study. The two-step method of Tsiatis et al. (J Am Stat Assoc 1995;90:27-37) was used to adjust for regression dilution bias, and results were compared with those obtained using more commonly applied methods of adjustment for regression dilution bias. It was found that the commonly used univariate adjustment for regression dilution bias overestimates the effects of both SBP and cholesterol compared with multivariate methods. Also, the two-step method makes better use of the information available, resulting in smaller confidence intervals. Results comparing recent and past exposure indicated that past SBP is more important than recent SBP in terms of its effect on coronary heart disease mortality, while both recent and past values seem to be important for effects of cholesterol on coronary heart disease mortality and effects of SBP on stroke mortality. Associations between serum cholesterol concentration and risk of stroke mortality are weak.
    Forty-year coronary mortality trends and changes in major risk factors in the first 10 years of follow-up in the seven countries study
    Menotti, A. ; Lanti, M. ; Kromhout, D. ; Blackburn, H. ; Nissinen, A. ; Dontas, A. ; Kafatos, A. ; Nedeljkovic, S. ; Adachi, H. - \ 2007
    European Journal of Epidemiology 22 (2007)11. - ISSN 0393-2990 - p. 747 - 754.
    monica project populations - heart-disease mortality - blood-pressure changes - all-cause mortality - cardiovascular-diseases - european cohorts - serbian cohorts - event rates - deaths - cholesterol
    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.
    Effects of Past and Recent Blood Pressure and Cholesterol Level on Coronary Heart Disease and Stroke Mortality, Accounting for Measurement Error
    Boshuizen, H.C. ; Lanti, M. ; Menotti, A. ; Moschandreas, J. ; Tolonen, H. ; Nissinen, A. ; Nedeljkovic, S. ; Kafatos, A. ; Kromhout, D. - \ 2007
    American Journal of Epidemiology 165 (2007)4. - ISSN 0002-9262 - p. 398 - 409.
    regression dilution bias - serum total cholesterol - all-cause mortality - cardiovascular-disease - follow-up - risk-factors - 7 countries - metaanalysis - age - underestimation
    The authors aimed to quantify the effects of current systolic blood pressure (SBP) and serum total cholesterol on the risk of mortality in comparison with SBP or serum cholesterol 25 years previously, taking measurement error into account. The authors reanalyzed 35-year follow-up data on mortality due to coronary heart disease and stroke among subjects aged 65 years or more from nine cohorts of the Seven Countries Study. The two-step method of Tsiatis et al. (J Am Stat Assoc 1995;90:27¿37) was used to adjust for regression dilution bias, and results were compared with those obtained using more commonly applied methods of adjustment for regression dilution bias. It was found that the commonly used univariate adjustment for regression dilution bias overestimates the effects of both SBP and cholesterol compared with multivariate methods. Also, the two-step method makes better use of the information available, resulting in smaller confidence intervals. Results comparing recent and past exposure indicated that past SBP is more important than recent SBP in terms of its effect on coronary heart disease mortality, while both recent and past values seem to be important for effects of cholesterol on coronary heart disease mortality and effects of SBP on stroke mortality. Associations between serum cholesterol concentration and risk of stroke mortality are weak.
    Determinants of longevity and all-cause mortality among middle-aged men. Role of 48 personal characteristics in 40-year follow-up of Italian Rural Areas in the Seven Countries Study.
    Menotti, A. ; Lanti, M. ; Maiani, G. ; Kromhout, D. - \ 2006
    Aging clinical and experimental research 18 (2006)5. - ISSN 1594-0667 - p. 394 - 406.
    coronary-heart-disease - cardiovascular risk-factors - factor intervention trial - body-mass index - physical-activity - blood-pressure - cholesterol - women - survival - smoking
    Background and aims: Forty-year all-cause mortality and its association with entry risk factor levels are reported for men enrolled in the Italian Rural Areas of the Seven Countries Study of Cardiovascular Diseases. Methods: Forty-eight potential risk factors were measured in 1712 men aged 40-59 at entry examination in 1960. Mortality data were collected during 40 years of follow-up. The relationship of entry risk factor levels with all-cause mortality was studied by univariate and multivariate approaches. Results: Overall death rate was 83.7%. The main causes of death were cardiovascular diseases, followed by cancer and others. The 48 risk factors were tested with univariate and multivariate approaches. In the final model, 15 risk factors were strongly and significantly related to all-cause mortality and survival. They were age, father and mother history of premature mortality, cigarette smoking, job-related physical activity (protective), body mass index (BMI) (in an inverse J-shaped fashion), mid-arm circumference (protective), mean blood pressure, forced respiratory volume in 314 seconds (protective), serum cholesterol, corneal arcus, xanthelasma, presence of cardiovascular diseases, cancer and diabetes at entry examination, Conclusions: During a 40-year period 15 mainly cardiovascular risk factors were highly predictive of all-cause mortality and survival in middle-aged men. (c) 2006, Editrice Kurtis.
    The relationship of age, blood pressure, serum cholesterol and smoking habits with the risk of typical and atypical coronary heart disease death in the European cohorts of the Seven Countries Study
    Menotti, A. ; Lanti, M. ; Nedeljkovic, S. ; Nissinen, A. ; Kafatos, A. ; Kromhout, D. - \ 2006
    International Journal of Cardiology 106 (2006)2. - ISSN 0167-5273 - p. 157 - 163.
    7 countries - population - failure
    Objective: To explore whether "typical" coronary heart disease (CHD) such as fatal myocardial infarction and sudden death relate to major cardiovascular risk factors in the same way as the "atypical" CHD, such as fatal heart failure and chronic arrhythmias. Design and setting: Ten cohorts (6633 cardiovascular disease-free men, aged 40-59) in five European countries were examined, age and three major risk factors were measured (systolic blood pressure, serum cholesterol, and smoking habits) and 35-year mortality data were collected. Proportional hazard models were solved with typical and atypical CHD deaths treated separately. Results: Death rates from typical and atypical CHD were inversely related among the five countries. Mean age at death was significantly higher for atypical than typical (75.8 versus 71.6 years; p <0.001). In the multivariate analysis conducted on pools of 5 countries (adjusted for countries), the relationship of risk factors with typical CHD was direct and significant for age (hazard ratio-HR-for 5 years of age 1.44 (95% CI 1.36-1.52)), systolic blood pressure (HR for 20 mm Hg, 1.39 (95% CI 1.32-1.47)), serum cholesterol (HR for 1 mmol/l of 1.22 (95% CI 1.16-1.27)) and smoking habits (HR smokers versus non-smokers of 1.39 (95% CI 1.24-1.57)). For atypical CHD, age had a larger HR of 2.27 (95% CI 2.05-2.52), systolic blood pressure had a smaller HR of 1.28 (95% CI 1.16-1.41), serum cholesterol had an inverse non-significant HR of 0.90 (0.58-1.58) and smoking habits had a larger HR of 1.54 (95% CI 1.26-1.89). Conclusions: Age and serum cholesterol were differently related with typical and atypical CHD deaths, suggesting different etiologies for these coronary diseases
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