Prevention of Coronary Heart Disease: Diet, Lifestyle and Risk Factors in the Seven Countries Study PDF
Preview Prevention of Coronary Heart Disease: Diet, Lifestyle and Risk Factors in the Seven Countries Study
PREVENTION OF CORONARY HEART DISEASE DIET, LIFESTYLE AND RISK FAC TORS IN THE SEVEN COUNTRIES STUDY Developments in Cardiovascular Medicine 232. A. Bayes de Luna, F. Furlanello, BJ. Maron and D.P. Zipes (eds.): Arrhythmias and Sudden Death in Athletes. 2000 ISBN: 0-7923-6337-X 233. J-C. Tardif and M.a. Bourassa (eds): Antioxidants and Cardiovascular Disease. 2000. ISBN: 0-7923-7829-6 234. J. Candell-Riera, J. Castell-Conesa, S. Aguade Bruiz (eds): Myocardium at Risk and Viable Myocardium Evaluation by SPET. 2000.ISBN: 0-7923-6724-3 235. M.H. EJlestad and E. Amsterdam (eds): Exercise Testing: New Conceptsfor the New Century. 2001. ISBN: 0-7923-7378-2 236. Douglas L. Mann (ed.): The Role of lnflammatory Mediators in the Failing Heart. 2001 ISBN: 0-7923-7381-2 237. Donald M. Bers (ed.): Excitation-Contraction Coupling and Cardiac Contractile Force, Second Edition. 2001 ISBN: 0-7923-7157-7 238. Brian D. Hoit, Richard A. Walsh (eds.): Cardiovascular Physiology in the Genetically Engineered Mouse, Second Edition. 2001 ISBN 0-7923-7536-X 239. Pieter A. Doevendans, A.A.M. Wilde (eds.): Cardiovascular Geneticsfor Clinicians. 2001 ISBN 1-4020-0097-9 240. 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 AU rights reserved. No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without the written permis sion from the Publisher, with the exception of any material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Permission for books published in Europe: [email protected] Permissions for books published in the United States of America: [email protected] Printed an acid-free paper. The Publisher offers discounts on this book for course use and bulk purchases. For jurther information, send email [email protected]. 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
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