Change in cardiovascular risk factors during a 10-year community intervention program.

The study describes changes in cardiovascular risk factors during 10 years of a community intervention program conducted in a rural area in Central Italy. Two areas were involved, one for treatment and one for reference. In 1983-84, 739 men and 859 women in the treatment area and 942 men and 1045 women in the control area, aged 20-69 years, were screened; total and HDL cholesterol, systolic and diastolic blood pressure, fasting blood glucose, smoking habit, weight and height were measured. Between 1983 and 1993 several intervention activities based on community medicine were carried out in the treatment area. They were based on interaction with the local socio-sanitary institutions and school system in order to influence individual persons, small groups and entire community. Major effort was addressed to mass health education, nutrition education, antismoking-propaganda and detection and treatment of hypertension, diabetes and hyperlipidemia.

Management of childhood obesity through a school-based programme of general health and nutrition education.

A school-based nutrition education programme aimed at the control of coronary risk factor rise during childhood was started in 1983 for 150 boys and girls aged 6-7 years. The study was performed in a rural area of central Italy, where adult obesity represents a major health problem. Preventive treatment was based on general health education in schools towards healthy lifestyles. Nutritional intervention was mainly focused on the adoption of the 'prudent diet'. School-teachers received specific training on how to teach 'good nutrition'. The nutrition curriculum was taught by teachers throughout the school year. Several meetings were organised to actively involve the children's parents. Practical recommendations for changes in food selection and preparation were also given. After a five-year follow up, a strong 'tracking phenomenon' for body mass index was observed, suggesting a great stability over time of lifestyles and dietary habits leading to the development of obesity during childhood. We conclude that a school-delivered programme of general nutrition education for the control of risk factors does not appear to be able to control child obesity.

Short term changes in cardiovascular risk factors in the Di.S.Co. Intervention Project. Research Group of the DI.S.Co. Project.

The Di.S.Co. Project--Sezze District Community Control--is aimed at achieving in the general population the prevention of chronic diseases through community intervention. Two areas are enrolled, one for intervention (25,706 subjects) and one for reference (12,655 subjects). In 1983 the first survey was conducted on a sample of males and females aged 20-69, and some risk factors for cardiovascular diseases were measured. In 1986 a second screening was conducted on the same sample examined in 1983 and in a new one to evaluate the effect of community treatment during the three-year intervention. The main net differences obtained in the treatment area against controls (by the paired analysis), adjusted by the initial levels of the risk factors considered, were: in males body mass index: -1.3% and number of cigarettes smoked per day: -5.1%; in females systolic blood pressure: -2.1%, body mass index: -3.2% and number of cigarettes smoked per day: -34.4%. The theoretical probability of death from atherosclerotic cardiovascular diseases in 25 years was estimated by the multiple logistic function and in three years it increased by 1% in males, while for females it decreased by 6.5%.

High density lipoprotein cholesterol distribution and predictive power in some Italian populations studies.

Nine Italian population samples, for a total of 12,365 males and 8,043 females aged 11 to 84, were examined. The age and sex distribution of HDL-cholesterol levels were calculated for studying its relationship with major cardiovascular risk factors, and for estimating its predictive power on coronary events and on all causes of mortality. Mean values of HDL-cholesterol in the pool of the samples ranged, according to different age groups, from 46.4 to 56.8 mg/dl in males and from 53.7 to 55.8 mg/dl in females. The linear correlation coefficients between HDL-cholesterol and 10 risk factors did not show high levels except those with triglycerides in men aged 20-34 (-0.33) and 35-64 (-0.34). Using the multiple linear regression model the levels of HDL-cholesterol were estimated as a function of the 10 risk factors solving 4 equations (for males, females and for two age groups, 20-34 and 35-64). The factors showing significant coefficients were body mass index (negative), triglycerides (negative), cigarette smoking (negative), alcohol consumption (positive), physical activity (positive), and non-HDL-cholesterol (negative). The Cox model was used for the prediction of coronary death and all causes of death and the logistic function for the prediction of coronary incidence in two of the studies on men aged 46-65 (6 year follow-up) and aged 60-79 (5 year follow-up), and including 5 other factors as possible confounders. Only the univariate prediction of coronary deaths in one study (men aged 46-65) provided a significant coefficient for HDL-cholesterol (t = -2.7624).

Serum thiocyanate levels as an objective measure of smoking habits in epidemiological studies.

The relationship between smoking habits and plasma thiocyanate levels has been evaluated in four adult samples of the general population containing men and women aged 20-84 and in a sample of 11-year-old non-smoking children of both sexes, for a total of 7577 individuals. Mean levels of plasma thiocyanate was found be approximately 20 mumol/l in children, 30 mumol/l in non-smoking adults and increasingly higher in smoking adults. The slopes of the regression equations of thiocyanate on cigarettes smoked per day range from 3.041 to 5.740, with correlation coefficients of from 0.638 to 0.809. In another occupational sample of 2802 men aged 46 to 65, where the correlation coefficient (between cigarette consumption and thiocyanate) was only 0.49, plasma thiocyanate was a better predictor of 4 year fatal events than cigarette consumption, 4 other covariates being considered in the same multivariate model.

[Various comparative data on the distribution of arterial pressure and on the prevalence of arterial hypertension in samples of the Italian population]. / Alcuni aspetti comparativi sulla distribuzione della pressione arteriosa e sulla prevalenza dell'ipertensione arteriosa in campioni di popolazione italiana

After a foreword concerning the present interest for the epidemiology of arterial hypertension mainly in relationship with the prevalence of the condition, its recognition in the general population and its systematic treatment, three separate chapters show the distribution of arterial blood pressure, its mean values and the prevalence of hypertension collected by three research groups: the Centre for Cardiovascular Diseases, St. Camillo Hospital, Rome, with 8 population groups (6929 subjects of whom 447 women, aged 20 to 64, belonging to the city of Rome and to other locations of 5 different regions); the II Medical Clinic, University of Padua, with 2 population groups (5852 men and women aged 20-64, belonging to a defined area of Veneto); the Research Group of the Roman Project of Coronary Heart Disease Prevention, with 2 population groups (2611 men aged 40-59, from Rome). The data provide a description of some characteristics of blood pressure and hypertension in different Italian areas and population groups and show the existence of large differences in the mean values of blood pressure and in the prevalence of hypertension, also within the country.