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Determinants of 40-year all-cause mortality in the European cohorts of the Seven Countries Study

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Abstract

If a few risk factors had predictive power for all-cause mortality in different geographical-cultural areas, then preventive efforts might be concentrated on these. Thirteen potential risk factors were measured in 6,554 men aged 40–59 around 1960 in Northern, Southern and Eastern European areas of the Seven Countries Study. In 40 years 85.3% of men died in the pooled areas (87.9, 81.8 and 87.9% in Northern, Southern and Eastern Europe, respectively). Six risk factors were significant predictors of events in all three areas: directly for age, smoking habits, mean blood pressure, heart rate and ECG abnormalities; inversely for forced expiratory volume. In a pooled model also father and mother life status, socio-economic status, and arm circumference (the last one in an inverse way) had significant coefficients that were not heterogeneous across areas (except for socio-economic status). Serum cholesterol was around significance. ROC curves had values of 0.833, 0.806 and 0.819 respectively in Northern, Southern and Eastern Europe, and 0.827 in the pooled areas. Correlation coefficients between observed and expected cases in deciles of estimated risk were between 0.98 and 0.99. Survivors after 40 years in the lower half of the estimated risk were 10.7, 23.6 and 13.3% in Northern, Southern and Eastern Europe, respectively. Under- or over-estimate of cross-applying risk functions did not exceed 15%. All-cause mortality and survival in middle aged men during 40 years were strongly associated with a few, mainly cardiovascular, risk factors, whose predictive power was similar in different cultures across Europe.

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References

  1. Anderson KM, Castelli WP, Levy D. Cholesterol and mortality. 30 years of follow-up from the Framingham study. JAMA. 1987;257:2176–80.

    Article  PubMed  CAS  Google Scholar 

  2. Inskip H, Beral V, McDowall M. Mortality of Shipham residents: 40-year follow-up. Lancet. 1982;1:896–9.

    Article  PubMed  CAS  Google Scholar 

  3. Rossow I, Amundsen A. Alcohol abuse and mortality: a 40-year prospective study of Norwegian conscripts. Soc Sci Med. 1997;44:261–7.

    Article  PubMed  CAS  Google Scholar 

  4. Goto A, Yasumura S, Nishise Y, Sakihara S. Association of health behavior and social role with total mortality among Japanese elders in Okinawa, Japan. Aging Clin Exp Res. 2003;15:443–50.

    PubMed  Google Scholar 

  5. Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L. NEDCOM, the Netherlands epidemiology and demography compression of morbidity research group. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138:24–32.

    PubMed  Google Scholar 

  6. Degrave E, Autier P, Grivegnée AR, Zizi M. All-cause mortality among Belgian military radar operators: a 40-year controlled longitudinal study. Eur J Epidemiol. 2005;20:677–81.

    Article  PubMed  Google Scholar 

  7. Frostad A, Søyseth V, Andersen A, Gulsvik A. Respiratory symptoms as predictors of all-cause mortality in an urban community: a 30-year follow-up. J Intern Med. 2006;259:520–9.

    Article  PubMed  CAS  Google Scholar 

  8. Imanishi R, Seto S, Ichimaru S, Nakashima E, Yano K, Akahoshi M. Prognostic significance of incident complete left bundle branch block observed over a 40-year period. Am J Cardiol. 2006;98:644–8.

    Article  PubMed  Google Scholar 

  9. Meisinger C, Wölke G, Brasche S, Strube G, Heinrich J. Postload plasma glucose and 30-year mortality among nondiabetic middle-aged men from the general population: the ERFORT study. Ann Epidemiol. 2006;16:534–9.

    Article  PubMed  Google Scholar 

  10. Brummett BH, Helms MJ, Dahlstrom WG, Siegler IC. Prediction of all-cause mortality by the Minnesota Multiphasic Personality Inventory Optimism-Pessimism scale scores: study of a college sample during a 40-year follow-up period. Mayo Clin Proc. 2006;81:1541–4.

    Article  PubMed  Google Scholar 

  11. Ruggiero C, Metter EJ, Melenovsky V, Cherubini A, Najjar SS, Ble A, et al. High basal metabolic rate is a risk factor for mortality: the Baltimore longitudinal study of aging. J Gerontol A Biol Sci Med Sci. 2008;63:698–706.

    PubMed  Google Scholar 

  12. Ferrie JE, Singh-Manoux A, Kivimäki M, Mindell J, Breeze E, Smith GD, et al. Cardiorespiratory risk factors as predictors of 40-year mortality in women and men. Heart. 2009;95:1250–7.

    Article  PubMed  CAS  Google Scholar 

  13. He J, McGee D, Niu X, Choi W. Examining the dynamic association of BMI and mortality in the Framingham Heart Study. Int J Environ Res Public Health. 2009;6:3115–26.

    Article  PubMed  Google Scholar 

  14. Holtermann A, Mortensen OS, Burr H, Søgaard K, Gyntelberg F, Suadicani P. Physical work demands, hypertension status and risk of ischemic heart disease and all-cause mortality in the Copenhagen Male Study. Scand J Work Environ Health. 2010;36:466–72.

    Article  PubMed  Google Scholar 

  15. Panagiotakos DB, Chrysohoou C, Pitsavos C, Menotti A, Dontas A, Skoumas J, et al. Corfu Cohort from the Seven Countries Study. Forty-years (1961–2001) of all-cause and coronary heart disease mortality and its determinants: the Corfu cohort from the Seven Countries Study. Int J Cardiol. 2003;90:73–9.

    Article  PubMed  Google Scholar 

  16. Moschandreas J, Kafatos A, Aravanis C, Dontas A, Menotti A, Kromhout D. Long-term predictors of survival for the Seven Countries Study cohort from Crete: from 1960 to 2000. Int J Cardiol. 2005;100:85–91.

    Article  PubMed  Google Scholar 

  17. Menotti A, Kromhout D, Blackburn H, Jacobs D, Lanti M. Forty-year mortality from cardiovascular diseases and all causes of death in the US Railroad cohort of the Seven Countries Study. Eur J Epidemiol. 2004;19:417–24.

    Article  PubMed  Google Scholar 

  18. Menotti A, Lanti M, Maiani G, Kromhout D. Determinants of longevity and all-cause mortality among middle-aged men. Role of 48 personal characteristics in a 40-year follow-up of Italian Rural Areas in the Seven Countries Study. Aging Clin Exp Res. 2006;18:394–406.

    PubMed  Google Scholar 

  19. Pelkonen M, Tukiainen H, Tervahauta M, Notkola IL, Kivelä SL, Salorinne Y, et al. Pulmonary function, smoking cessation and 30 year mortality in middle aged Finnish men. Thorax. 2000;55:746–50.

    Article  PubMed  CAS  Google Scholar 

  20. Pelkonen M, Notkola IL, Nissinen A, Tukiainen H, Koskela H. Thirty-year cumulative incidence of chronic bronchitis and COPD in relation to 30-year pulmonary function and 40-year mortality: a follow-up in middle-aged rural men. Chest. 2006;130:1129–37.

    Article  PubMed  Google Scholar 

  21. Keys A (ed), Blackburn H, Menotti A, Buzina R, Mohacek I, Karvonen MJ, et al. Coronary heart disease in seven countries. Circulation 1970;41(suppl 1):1–211.

    Google Scholar 

  22. Keys A (ed), Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS et al. Seven Countries Study. A multivariate analysis of death and coronary heart disease. Cambridge: Harvard Univ Press; 1980. pp 1–381.

  23. Morris JN. Uses of epidemiology, vol. 3. London: Edinburgh; 1975. p. 1–318.

    Google Scholar 

  24. Rose G, Blackburn H. Cardiovascular survey methods. World Health Organization: Geneva; 1968. p. 1–188.

    Google Scholar 

  25. Anderson JT, Keys A. Cholesterol in serum and lipoprotein fractions: its measurement and stability. Clin Chem. 1956;2:145–59.

    PubMed  CAS  Google Scholar 

  26. Menotti A, Blackburn H, Kromhout D, Nissinen A, Adachi H, Lanti M. Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study. Eur J Epidemiol. 2001;17:337–46.

    Article  PubMed  CAS  Google Scholar 

  27. Dyer AR. A method for combining results from several prospective epidemiological studies. Stat Med. 1986;5:303–17.

    Article  PubMed  CAS  Google Scholar 

  28. 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.

    PubMed  Google Scholar 

  29. May M. Commentary: improved coronary risk prediction using neural networks. Int J Epidemiol. 2002;31:1262–3.

    Article  Google Scholar 

  30. Buijsse B, Feskens EJ, Moschandreas J, Jansen EH, Jacobs DR Jr, Kafatos A, et al. Oxidative stress, and iron and antioxidant status in elderly men: differences between the Mediterranean south (Crete) and northern Europe (Zutphen). Eur J Cardiovasc Prev Rehabil. 2007;14:495–500.

    Article  PubMed  Google Scholar 

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Acknowledgments

The Authors acknowledge the late Prof Ancel Keys who was the founder and leader of the Seven Countries Study for many years. This investigation was undertaken under the rules of the Seven Countries Study third generation study group. Appreciation is expressed to the first and second generation of principal investigators in each country. Prof Henry Blackburn, and Prof David Jacobs, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, USA, Prof Daan Kromhout, Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands, Prof Aulikki Nissinen, National Institute for Health and Welfare, Helsinki, Finland and Prof Anastasios Dontas, Athens, Greece provided valuable comments and critical reading.

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Correspondence to Paolo Emilio Puddu.

Appendix

Appendix

See Table 5, 6, 7, 8, 9, 10 and 11.

Table 5 Mortality in 40 years in the three areas and their pool, expressed per 1,000 person/years
Table 6 Proportional hazards models predicting 40-year all-cause mortality in Finland
Table 7 Proportional hazards models predicting 40-year all-cause mortality in The Netherlands
Table 8 Proportional hazards models predicting 40-year all-cause mortality in Italy
Table 9 Proportional hazards models predicting 40-year all-cause mortality in Greece
Table 10 Proportional hazards models predicting 40-year all-cause mortality in Serbia
Table 11 Multiple linear regression model with survival time in years as dependent variable and risk factors as independent variable in the pool of all areas (N = 6,554)

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Puddu, P.E., Menotti, A., Tolonen, H. et al. Determinants of 40-year all-cause mortality in the European cohorts of the Seven Countries Study. Eur J Epidemiol 26, 595–608 (2011). https://doi.org/10.1007/s10654-011-9600-7

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  • DOI: https://doi.org/10.1007/s10654-011-9600-7

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