Antihypertensive treatment is not a risk factor for major cardiovascular events in the Gubbio residential cohort study.

BACKGROUND AND OBJECTIVES: Demonstration of antihypertensive beneficial role in population settings is difficult. Relationships of antihypertensive treatment, blood pressure control, risk factors and cardiovascular outcomes were investigated in the Gubbio study. MATERIAL AND METHODS: Among 2248 cardiovascular disease-free men and women aged 35-74 years, individuals were classified as nonhypertensive, controlled hypertensive, uncontrolled hypertensive and untreated hypertensive based on cut-off limits of 140/90  mmHg for SBP/DBP and/or the use of antihypertensive drugs. End-point was the first major coronary, cerebrovascular or peripheral hard event [cardiovascular disease (CVD)] during a 15-year average. Univariate and multivariate analyses were run. RESULTS: Nonhypertensive individuals were about 10 years younger and had lower risk factor levels than the other categories. The relative risk (and 95% confidence interval) for CVD versus nonhypertension was 1.78 (1.02-3.10) for controlled hypertension, 3.76 (2.79-5.06) for uncontrolled hypertension and 3.30 (2.59-4.21) for untreated hypertension (UTH). After adjusting for covariates, such as sex, age, achieved blood pressure and other risk factors, the CVD risk of controlled hypertension was practically equal to that of nonhypertension, and remained unchanged even when blood pressure was excluded from the model (1.03, 0.58-1.82). The higher cardiovascular risk of uncontrolled hypertension and UTH was reduced after adjusting for covariates, but remained significantly higher than in nonhypertension, with no significant differences between uncontrolled hypertension and UTH. CONCLUSIONS: A higher level of baseline risk is not due to treatment per se, the risk being similar in uncontrolled hypertension and UTH. Adjustment for risk factors reduces the risk only in controlled hypertension, suggesting that there may be structural alterations scarcely reversible by antihypertensive treatment.

Heritability of blood pressure through latent curve trajectories in families from the Gubbio population study.

BACKGROUND AND OBJECTIVES: Prospective investigations on cardiovascular risk factors in populations provide a unique opportunity to dissect time-dependent quantitative complex traits, such as arterial blood pressure (BP), into their polygenic and environmental components. BP heritability analyses were carried out on 2620 patients belonging to 711 nuclear pedigrees that could be followed up throughout 25 years in the Gubbio Population Study. METHODS: Each patient's BP serial measurements were summarized into individual intercepts (expected values at baseline) and slopes (time-related changes), which were predicted through latent curve models. These models considered either age in years or waves (times from the first survey) as time axis and were linked at a family level in the heritability analyses using additive polygenic-common environment-unique error models adjusted for sex, age and clinical variables. RESULTS: The additive genetic effect explained 32-49% of the variance of SBP values at baseline, the wave-dependent analysis with nuclear pedigrees and the sibs-household matrix accounting for higher heritability values. Heritability of DBP baseline value was lower than that of SBP in analyses by age (5-15%), but fell in the same heritability range as SBP on the analysis by waves (36-37%). The BP variation over time (slope) explained by an additive genetic effect ranged from 33 to 43% and from 24 to 25% for SBP and DBP, respectively, in the analysis by age. Shared environment also exerted a significant influence, but explained a smaller portion of the variances (4-17%) for both traits. CONCLUSION: Longitudinal data from the Gubbio population show strong to moderate genetic influences on SBP and DBP baseline values and changes over time with a smaller, though significant, effect of environment.

Epidemiology of typical coronary heart disease versus heart disease of uncertain etiology (atypical) fatalities and their relationships with classic coronary risk factors.

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 ¾ 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.

Cardiovascular risk factors predict survival in middle-aged men during 50 years.

OBJECTIVES: We aimed at studying the expectancy of life in middle-aged men as a function of several personal characteristics and risk factors. MATERIAL AND METHODS: A sample of 1712 Italian men aged 40-59, first examined in 1960, was followed-up for mortality for 50 years. The length of survival was estimated as a function of 48 personal characteristics and risk factors using the multiple linear regression. RESULTS: In 50 years 1672 men died (97.7%) and 40 survived (2.3%). Twenty risk factors, most of which were never measured in previous studies of such duration, proved to be significant, for the estimation of survival with an overall adjusted R(2) of 0.3236. They were: age, 4 anthropometric measurements (body mass index, and its squared term, laterality-linearity index, shoulder/pelvis shape), mean blood pressure, father and mother history of premature (<65-year) death, marital status, arm circumference, 2 respiratory measurements (vital capacity and forced expiratory volume), serum cholesterol, corneal arcus, xantelasma, cancer, cardiovascular diseases, diabetes and chronic bronchitis. Coefficients of 5 suitable risk factors became definitely larger after adjustment for regression dilution bias with 5 year data. All 40 cases of survival were located in the higher 5 deciles of estimated survival and 25 (62.5%) were in the upper decile. CONCLUSION: A small number of risk factors and personal characteristics, mainly known as cardiovascular risk factors and measured once in middle-aged men, are strongly associated with the length of survival in a 50-year follow-up.

Factor analysis in the identification of dietary patterns and their predictive role in morbid and fatal events.

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.

Survey of cardiovascular risk factors in overweight and obese patients (SCOOP study) six-month changes in risk factor levels and cardiovascular risk.

BACKGROUND: Obesity is considered a major threat to health worldwide, and its treatment is difficult. The SCOOP project is aimed at describing the effects of treating obesity in everyday clinical practice, following a standard protocol of weight reduction. METHODS: A total of 2472 obese or overweight men and women (with a body mass index of 27 units or more), aged between 35 and 74, were enrolled in different clinical facilities. Treatment included a 25% average reduction in caloric intake and a recommendation to take a brisk walk for at least 150 min per week. After 6 months, a second survey was then carried out. RESULTS: At the entry examination, patients exhibited high levels of most cardiovascular risk factors and estimated cardiovascular risks, and a high prevalence of cardiovascular diseases (14.1% in men; 6.3% in women), diabetes (30.5% in men; 25.2% in women) and metabolic syndrome (25.6% in men; 22.8% in women). After 6 months, 69% of all enrolled patients reported for a final examination. Levels of all cardiovascular risk factors were significantly reduced, including estimated cardiovascular risks (-20.4% in men and -12.6% in women). A targeted 10% reduction in body weight was achieved by 19% of patients. Changes in weight and cardiovascular risk factors were highly correlated with the self-reported compliance to prescriptions, and graded with the observed weight reduction. Benefits should be lowered by 30% if it is assumed that the patients who did not show up at the follow-up did not change their characteristics. CONCLUSION: Short term positive effects of treatment of obesity can be obtained in everyday clinical practice using a simple protocol.

Twenty-year cardiovascular and all-cause mortality trends and changes in cardiovascular risk factors in Gubbio, Italy: the role of blood pressure changes.

AIMS: In an observational population study that lasted 20 years, the relationships between mortality trends and changes in cardiovascular risk factor levels were examined. METHODS AND RESULTS: In the town of Gubbio, in central Italy, population surveys for measurement of cardiovascular risk factors were performed 20 years apart. In a subset of the initial cohort (1927 men and 2333 women), mortality data were collected for 20 years. Cardiovascular risk factor levels were compared in individuals in the same age range (20-79 years) examined at the initial survey (1927 men and 2333 women) and at the final survey (1761 men and 2055 women). Age-adjusted rates significantly declined, by 28% among men and 51% among women, for all causes of death, and by 50% among men and 71% among women for cardiovascular disease deaths. Declines were observed in the levels of systolic blood pressure, serum cholesterol, resting heart rate, smoking habits, BMI, plasma glucose (the latter two only in women) and the estimated cardiovascular risk, together with increases in serum high-density lipoprotein cholesterol and in the proportion of treated and controlled hypertensive patients. CONCLUSION: Although similar but less impressive changes were recorded in Italy at large, the existence of the observational study in Gubbio might have motivated the general population and the medical profession towards actions promoting general health.

Homogeneity in the relationship of serum cholesterol to coronary deaths across different cultures: 40-year follow-up of the Seven Countries Study.

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.

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

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.

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 a 40-year follow-up of Italian Rural Areas in the Seven Countries Study.

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 3/4 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.

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.

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.

Long-term trends in major cardiovascular risk factors in cohorts of aging men in the European cohorts of the Seven Countries Study.

BACKGROUND AND AIMS: Time trends in major cardiovascular risk factors are described in cohorts of middle-aged men followed for 35 years in 9 European cohorts of Finland, The Netherlands, Italy, Serbia and Greece. METHODS: Men aged 40 to 59 years at entry in the early 1960s were repeatedly re-examined 3 to 5 times over the last 35 years. Systolic blood pressure, serum cholesterol, body weight and body mass index were considered for analysis, including study of aging (35 years of follow-up) and of generation effects (10 years for men aged 50-59 in the period 1960-1970 and separately 10 years for men aged 75-84 years in the period 1985-1995). RESULTS: For the aging effect, average systolic blood pressure increased approximately 15 mmHg over 25 years maintaining a steady state thereafter, the largest increases being found in Serbia and Greece. Average serum cholesterol varied between approximately 4.5 in Serbia and 6.5 mmo/L in Finland in about 1960. Twenty-five years later, the average level was about 6 mmol/L in all five countries and decreased slightly thereafter. Average body weight and body mass index increased in all countries for 25 years and levelled off thereafter. For the generation effect, average systolic blood pressure decreased in all countries, with the exception of men aged 50-59 in Serbia and men aged 75-84 in The Netherlands. Average serum cholesterol uniformly increased in men aged 50-59 for the younger age-class and slightly decreased in men aged 75-84. Average body weight and body mass index increased systematically in all countries and in both age groups. CONCLUSIONS: Major changes were the great increases in average systolic blood pressure and serum cholesterol level in Serbia and in systolic blood pressure level in Greece between 1960 and 1985, and the large decrease in average serum cholesterol in Finland between 1970 and 1995. Average body weight and body mass index showed universal increases in both middle-aged and older men after 1960.

Riskard 2005. New tools for prediction of cardiovascular disease risk derived from Italian population studies.

BACKGROUND AND AIM: The need to update tools for the estimate of cardiovascular risk prompted the "Gruppo di Ricerca per la Stima del Rischio Cardiovascolare in Italia" to produce a new chart and new software called Riskard 2005. METHODS AND RESULTS: Data from 9 population studies in 8 Italian regions, for a grand total of 17,153 subjects (12,045 men and 5,108 women) aged 35-74 and for a total exposure of about 194,000 person/years were available. A chart for the estimate of cardiovascular risk (major coronary, cerebrovascular and peripheral artery disease events) in 10 years was produced for men and women aged 45-74 free from cardiovascular diseases. Risk factors employed in the estimate were sex, age (6 classes), systolic blood pressure (4 classes), serum cholesterol (5 classes), diabetes, and cigarette smoking (4 classes). Estimates were produced for absolute risk and for relative risk, the latter against levels expected in the general population that produced the risk functions. Software was produced for the separate estimate of major coronary, cerebrovascular and cardiovascular events (the latter made by coronary, cerebrovascular and peripheral artery disease of atherosclerotic origin) for follow-up at 5, 10 or 15 years, in men a women aged 35-74 years at entry and free from cardiovascular diseases. Risk factors employed here were sex, age, body mass index, mean physiological blood pressure, HDL cholesterol, non-HDL cholesterol, cigarette smoking, diabetes and heart rate. The output is based on several indicators: absolute risk, relative risk (as defined above), ideal risk (for a very favourable risk profile), biological age of risk, comparisons among the above indicators, the percent contribution of risk factors to the excess of estimated risk above the level of the ideal risk, and the description of trends in risk estimate in relation to repeated measurements. CONCLUSIONS: These tools represent progress compared to similar tools produced some years ago by the same Research Group.

Forty-year mortality from cardiovascular diseases and their risk factors in men of the Italian rural areas of the Seven Countries Study.

OBJECTIVE: Forty-year cardiovascular 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 AND RESULTS: Cardiovascular risk factors were measured in 1712 men aged 40-59 years at entry examination in 1960. Mortality data were collected during 40 years of follow-up. Overall death rate was 83.7%. The main causes of death were cardiovascular diseases, with a preponderance of those of atherosclerotic origin (CVDA, 33.7 % of all causes) including coronary heart disease, stroke and peripheral arterial diseases. Using 14 risk factors measured at baseline, multivariate analysis for CVDA showed that seven of them were strongly and significantly associated with events. The multivariate hazard ratio for 5 years of age was 1.59 (CI 1.43-1.77); for heavy job-related physical activity it was 0.96 (CI 0.79-1.18); for 10 cigarettes smoked per day 1.16 (CI 1.05-1.28); for 20 mm Hg of systolic blood pressure 1.38 (CI 1.25-1.52); for 1 mmol/l of serum cholesterol 1.19 (CI 1.09-1.30); for 0.25 l/m2 of height of vital capacity 0.87 (CI 0.78-0.97); for the presence of corneal arcus 1.36 (CI 1.03-1.79). Risk factors of which the coefficient did not reach statistical significance were family history for cardiovascular diseases, forced expiratory volume, heart rate, mid-arm circumference, subscapular skinfold, body mass index and diabetes. Similar findings were obtained for CHD and partially for stroke mortality. CONCLUSIONS: During a 40-year period classical cardiovascular risk factors were still highly predictive of cardiovascular diseases of atherosclerotic origin in these Italian rural populations.

Short and long term association of a single serum cholesterol measurement in middle-aged men in prediction of fatal coronary and other cardiovascular events: a cross-cultural comparison through Europe.

AIMS: The purpose was to study the association of a single serum cholesterol measurement with early and late coronary and other cardiovascular deaths during 35 years of follow-up in samples of men aged 40-59 years in five European countries. METHODS AND RESULTS: A single serum total cholesterol measurement was considered in samples from Finland (N = 1563), the Netherlands (N = 811), Italy (N = 1642), Serbia (N = 1537) and Greece (N = 1158) (total = 6711). Seven partitioned proportional hazards models were solved, one for each of seven independent 5-year blocks, to predict coronary, stroke, cardiovascular disease and all-cause mortality risk. Partitioned hazard scores were cumulated. The resulting curves showed a relatively constant strength in risk for coronary deaths as a function of baseline serum cholesterol levels, although a strong relationship during the first 10-year period was followed by a weaker relationship later on. The pooled estimates for the five countries gave a relative risk for 1 mmol/l of serum cholesterol (95% confidence intervals) of 1.44 (1.23-1.68) for the first period; 1.52 (1.31-1.76) for the second period; and 1.16 (1.02-1.32) for the third period; 1.18 (1.05-1.32) for the forth period; 1.17 (1.05-1.31) for the fifth period; 1.22 (1.10-1.35) for the sixth period; 1.18 (1.05-1.32) for the seventh 5-year period of follow-up. No significant relationship were found between serum cholesterol and stroke and all-cause mortality, while intermediate findings were obtained for cardiovascular diseases. CONCLUSION: A single serum cholesterol measurement in middle aged-men maintains a strong relationship with the occurrence of coronary heart disease (CHD) deaths during 35 years of follow-up.

Early and late coronary deaths in the US Railroad study predicted by major coronary risk factors.

BACKGROUND: The purpose of this study was to explore the duration of the association of major coronary risk factors measured on a single occasion with coronary heart disease (CHD) deaths during 40 years in a population sample of middle-aged men. DESIGN: Measurement of age, systolic blood pressure, serum total cholesterol, and cigarette smoking was made on a single occasion in 2376 cardiovascular disease free men, aged 40-59, belonging to the US Railroad cohort of the Seven Countries Study enrolled in the late 1950s. During 40 years of follow up 627 men died from typical CHD (sudden death coronary death or definite myocardial infarction). METHODS: Eight partitioned proportional hazards models were solved, one for each independent 5-year block of follow up, to predict the risk of CHD death. Eight 5-year partitioned hazard scores, derived from the coefficients, were cumulated for each risk factor. RESULTS: The resulting curves showed a regularly increasing time trend in risk for coronary deaths as a function of serum cholesterol, systolic blood pressure and cigarette smoking, for the first 30-35 years of follow up followed by a loss of predictive power thereafter. The curves fit straight lines, with large squared correlation coefficients ranging from 0.96 to 0.99. There was a relatively constant strength in the association of risk factors levels with events, which are predicted irrespective of the distance from risk factor measurements. CONCLUSIONS: Measurement of major coronary risk factors taken on a single occasion in middle-aged men maintained a regular and almost monotonic relationship with the subsequent occurrence of CHD deaths for at least 30-35 years of follow up.

Time trends in three triennial surveys of cardiovascular risk factors and their treatment among patients discharged from divisions of internal medicine The FAPOI-1, FADOI-2, and FADOI-3 studies.

BACKGROUND: There is increasing interest in monitoring cardiovascular risk factor levels and their treatment. We decided to study this in patients discharged from Divisions of Internal Medicine. METHODS: In three studies conducted in 1996, 1999, and 2002, data was collected on diagnoses of cardiovascular diseases and cardiovascular risk factor levels and treatment in 5904, 7476, and 9649 patients, respectively, aged 35 years or older, who were discharged within a week from 235, 345, and 517 Divisions of Internal Medicine in Italy. RESULTS: Between the first and third surveys, a relative decrease in atherosclerotic cardiovascular diseases was recorded, but heart failure showed a definite increase, reaching 11% of all cases. Mean levels of most cardiovascular risk factors decreased significant; only obesity did not. The proportion of treated hypertensives increased slightly (from 65% to 83% among men, and from 69% to 85% among women). The proportion of controlled hypertensives also rose, reaching around 37%. The proportion of treated dyslipidemics increased from 10% to 28% in men and from 12% to 25% in women, due to an increase in the use of statins. CONCLUSIONS: It is essential to focus attention on cardiovascular risk factors in order to optimize their treatment and to reduce cardiovascular disease.