Prevention of Coronary Heart Disease: Diet, Lifestyle and Risk Factors in the Seven Countries Study

266 Pages·2002·16.607 MB·English

by  Henry Blackburn (auth.), Daan Kromhout, Alessandro Menotti, Henry Blackburn (eds.)

PREVENTION OF CORONARY HEART DISEASE
DIET, LIFESTYLE AND RISK FAC TORS
IN THE SEVEN COUNTRIES STUDY
Developments in Cardiovascular Medicine
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238. Brian D. Hoit, Richard A. Walsh (eds.): Cardiovascular Physiology in the
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239. Pieter A. Doevendans, A.A.M. Wilde (eds.): Cardiovascular Geneticsfor Clinicians.
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240. Stephen M. Factor, Maria A.Lamberti-Abadi, Jacobo Abadi (eds.): Handbook of
Pathology and Pathophysiology of Cardiovascular Disease. 2001
ISBN 0-7923-7542~4
241. Liong Bing Liem, Eugene Downar (eds): Progress in Catheter Ablation. 2001
ISBN 1-4020-0147-9
242. Pieter A. Doevendans, Stefan Kăăb (eds): Cardiovascular Genomics: New
Pathophysiological Concepts. 2002 ISBN 1-4020-7022-5
243. Daan Kromhout, Alessandro Menotti, Henry Blackburn (eds): Prevention of
coronary heart disease Diet, lifestyle and riskfactors in the Seven Countries Study.
2002 ISBN 1-4020-7124-8
Previous volumes are still available
PREVENTION OF CORONARY HEART DISEASE
DIET, LIFESTYLE AND RISK FAC TORS
IN THE SEVEN COUNTRIES STUDY
Editors:
Daan Kromhout
Professor
Director Nutrition and Consumer Safety Division
National Institute of Public Health and the Environment
P.O.Box 1,3720 BA Bilthoven
The Netherlands
Alessandro Menotti
Professor
Association for Cardiac Research
Cardioricerca
Via Adda 87
Rome 00198
Italy
Hemy Blackburn
Mayo Professor Emeritus
Division of Epidemiology
School of Public Health
University ofMinnesota
1300 South Second Street,
Minneapolis, MN 55454-1015,
U.S.A.
Springer Science+Business Media, LLC
ISBN 978-1-4613-5402-4 ISBN 978-1-4615-1117-5 (eBook)
DOI 10.1007/978-1-4615-1117-5
Library of Congress Cataloging-in-Publication Data
A C.I.P. Catalogue record for this book is available
from the Library of Congress.
Copyright © 2002 by Springer Science+Business Media New York
OriginaUy published by Kluwer Academic Publishers in 2002
Softcover reprint ofthe hardcover Ist edition 2002
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Prevention ofcoronary heart disease
Diet, lifestyle and risk factors
in the Seven Countries Study
DaanKromhout, Alessandro Menotti, HenryBlackburn (Editors)
DedicatedtoAncelKeys,
distinguishedscientist, who
conceived, organized, and for
manycollegialyearsdirected
theSevenCountries Study
Contents
Contents Vll
Preface IX
Foreword xi
Acknowledgements xiii
1. PartI: Background and theburden ofcardiovasculardiseases 1
1.1. ObjectivesandhistoryoftheSevenCountries Study 3
HenryBlackburn
1.2. Populationsandorganizationofthesurveys
inthe SevenCountriesStudy 9
AlessandroMenotti
1.3. Prevalenceand incidenceofcardiovasculardiseases
inthe SevenCountries Study 15
AlessandroMenotti
1.4. Cardiovascularandall-causesmortalitypatterns
inthe SevenCountries Study 27
Alessandro Menotti, MariapaolaLanti
2 PartII: Diet, lifestyle andcoronaryheartdisease 41
2.1. Dietand coronaryheartdisease
inthe SevenCountries Study 43
DaanKromhout, BennieBloemberg
2.2. Dietandcoronaryheartdisease
inthe ZutphenStudy 71
DaanKromhout, BennieBloemberg
2.3. Cigarette smoking, coronaryheartdiseaseand all-causes mortality
inthe SevenCountriesStudy 85
DaanKromhout
2.4. Alcoholandcoronaryheartdisease
inthe SevenCountries Study 97
DaanKromhout
2.5. Physicalactivity,physicalfitness andcoronaryheartdisease
inthe SevenCountries Study 109
AlessandroMenotti
3 PartIII: Biological riskfactors andcoronaryheartdisease 125
3.1 Serumcholesteroland coronaryheartdisease
inthe SevenCountries Study 127
DaanKromhout
3.2 Bloodpressureand cardiovasculardiseases
inthe SevenCountries Study 145
AlessandroMenotti
3.3 Bodyfatness, coronaryheartdisease andall-causes mortality
inthe SevenCountries Study 165
DaanKrornhout
3.4 Type2diabetes, glucosetolerance and cardiovasculardiseases
inthe SevenCountries Study 183
DaanKrornhout, EdithFeskens
3.5 Electrocardiographicpredictorsofcoronaryheartdisease
inthe SevenCountries Study 199
AlessandroMenotti, HemyBlackburn
3.6 Multivariateanalysisofmajorriskfactors andcoronaryrisk
inthe SevenCountries Study 213
Alessandro Menotti
4 PartIV: Implicationsoffindings oftheSevenCountries Study 227
4.1 Riskfactors for globalcoronaryriskinpreventiveandclinical
cardiology 229
Alessandro Menotti, DaanKrornhout
4.2 Diet, lifestyleandpreventionofcoronaryheartdisease
Theintegrationofobservationalandexperimentalevidence 241
DaanKrornhout, BennieBloemberg, AlessandroMenotti
4.3 Epilogue for the SevenCountries Study 251
HemyBlackburn
Appendix 255
Index 257
viii
Preface
In the 1940s I was struckbyreports about many apparently healthy middle-aged men
who dropped dead instantly from heart attacks. The causes of these sudden deaths
were unknown. I was interested to discover physio-chemical characteristics of
individuals with predictive value for the occurrence ofthese fatal heart attacks. The
discoveryofpreventivevariables wouldpointways topreventthis disease.
In order to find relationships between mode of life and susceptibility to heart
disease contrasting populations had to be studied. Variety - not a high degree of
homogeneity in culture and habits - must be sought. After exploratory surveys in
countries with supposed differences in dietary patterns, lifestyle and heart disease
rates in the early 1950s, the Seven Countries Study took off in 1958. This study
established relationships between risk factors and development of heart disease in
middle-aged men in health examined in countries with cultures we demonstrated to
contrast in diet and lifestyle. The results obtained in the Seven Countries Study from
its inceptiontill now are presented in this bookentitled: "Prevention ofcoronaryheart
disease. Diet, lifestyleandrisk factors inthe Seven Countries Study."
Long ago I realized that our concern should not be restricted to the prevention of
coronary heart disease but should be extended to all diseases and premature death. It
is therefore necessary that characteristics ofpeople were recorded and the follow-up
ofpopulations continueduntil there was achange ofvital status, providing the data to
associate conditions inhealth withchanges in thatvital status. The first applicationof
that idea was a prospective study of283 men in Minnesota who were first examined
in 1947. The follow-up showed that the numbers were too small to find meaningful
relationships. Larger numbers were needed and were obtained in the SevenCountries
Study.
The results ofthe SevenCountries Studypresented in this bookshould be viewed
in this broader context ofthe role ofdiet, lifestyle and risk factors in relation to all
causes deaths and to longevity. This should be the ultimate goal of epidemiologic
research.
Minneapolis Ancel Keys
January2002
Foreword
Inthe secondhalfofthe lastcentury, epidemiological and experimental evidence was
presented that the development of coronary heart disease is related to cigarette
smoking, the blood cholesterol, and blood pressure level, a family history of the
disease and other factors. This type of evidence was later supported by that of
intervention trials, which demonstrated a reduction in incidence of coronary heart
disease by smoking cessation, lowering blood cholesterol and lowering blood
pressure.
The epidemiological evidence was collected in a series of observational studies
within specific populations, and by studies across different populations and cultures.
The Seven Countries Study, initiated by Ancel Keys from Minneapolis, Minnesota,
U.S.A., compared population characteristics and the presence and development of
coronary heart disease across seven countries in North America, Europe and Japan.
These studies were continued by his collaborators and successors, following the
originalpopulationsoverfour decades.
The Seven Countries Study showed that major differences in personal
characteristics, lifestyle and diet across the study populations were associated with
largedifferences inprevalenceandincidence ofcoronaryheartdisease. During follow
up it was established that the levels ofmajor risk factors were associated with the
population and the individual risk for future coronary heart disease events. While
initial epidemiological studies focused on single risk factors, the Seven Countries
Studyandotherstudiesdemonstratedthe conceptthatsuchriskis multifactorial.
In the last decades we have observed a reduction in the deaths and incidence of
early coronary heart disease in Western European and North American populations.
This reduction is most likely related to improved coronary care and to reduction of
several risk factors in the population, albeit that one of the strongest risk factors,
smoking, has notbeenabolished. This reduction inpopulationrisk is certainlyrelated
to the impact of the Seven Countries Study together with other epidemiological
studies, preventive practice, and public policy. More recently, clinical trials have
shownareductioninrisk ofdevelopmentofcoronaryheart disease through reduction
ofbloodpressure andbloodcholesterollevels.
In this book, an overview is given of the results ofthe Seven Countries Study,
with detailed descriptions ofthe populations which were studied, the prevalence and
incidence ofcoronaryheart disease in the seven countries, and the impact ofspecific
risk factors as smoking, diet, physical activity, overweight, cholesterol and blood
pressure levels, as well as diabetes. As such, this book contains important reference
material for epidemiologists, physicians, and health care authorities interested in
coronary heart disease, which remains the number one cause of death in Western
Europe and North America, and which will shortly be the most prominent cause of
deathanddisabilityinallcontinents.
The European Society of Cardiology, the American Heart Association, the
European Atherosclerosis Society, the European Society for Hypertension, the Heart
Foundations and many other organizations share a mission to improve the quality of
life and life expectancy through reduction ofcardiovascular diseases. The measures
proposed by these organizations to reduce cardiovascular risk in the population, and
to improve prognosis ofindividuals includingpatients withestablishedcoronaryheart
disease, have been derived from observations such as the Seven Countries Study.
Accordingly, I strongly recommend this book to all who are interested in fighting
heartdiseaseandstroke.
MaartenL.Simoons, M.D.
ProfessorofCardiology
Thoraxcenter
ErasmusMedicalCenter
Rotterdam, TheNetherlands
PresidentEuropeanSocietyofCardiology
xii