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Cardiovascular Mortality in 10 Cohorts of Middle-Aged Men Followed-Up 60 Years until Extinction: The Seven Countries
Alessandro Menotti1, Paolo Emilio Puddu1,2, Anthony G Kafatos3
1Association for Cardiac Research, 00182 Rome, Italy.
Insights
Cardiovascular disease (CVD) mortalities varied by type and country, with coronary heart disease (CHD) linked to high cholesterol and stroke to lower levels. Lifelong CVD death differences were smaller than anticipated, influenced by baseline cholesterol.
Area of Science:
- Epidemiology
- Cardiovascular Medicine
- Public Health
Background:
- Cardiovascular diseases (CVDs) represent a significant global health burden.
- Understanding variations in CVD mortality across different populations is crucial for targeted prevention strategies.
- Major CVD groups include coronary heart disease (CHD), cerebrovascular diseases (STROKE), and other heart diseases of uncertain etiology (HDUE).
Purpose of the Study:
- To investigate long-term mortality patterns for three major cardiovascular disease (CVD) groups.
- To analyze CVD mortality differences across diverse international cohorts.
- To identify common and distinct risk factors for CHD, STROKE, and HDUE.
Main Methods:
- Pooled analysis of ten male cohorts (N=9063) aged 40-59 from six countries.
- Longitudinal follow-up for up to 60 years to ascertain mortality causes.
- Categorization of CVD deaths into CHD, STROKE, and HDUE for comparative analysis.
Main Results:
- Coronary heart disease (CHD) mortality was higher in high-serum cholesterol countries, while STROKE and HDUE showed the opposite trend.
- Systolic blood pressure and smoking were universal individual-level risk factors for all CVD groups.
- Serum cholesterol was a specific risk factor for CHD, but not for STROKE or HDUE.
Conclusions:
- Despite varying individual risk factors, overall lifelong CVD mortality differences between countries were less pronounced than expected.
- The differing mortality rates of CHD, STROKE, and HDUE contributed to smaller overall CVD mortality disparities.
- Baseline serum cholesterol levels appeared to be an indirect determinant influencing these observed patterns.
Objectives:
To investigate mortalities from three major groups of cardiovascular diseases (CVDs) in a pooled cohort and followed up until extinction.
Materials And Methods:
Ten cohorts of men (N = 9063) initially aged 40-59, in six countries, were examined and followed-up for 60 years. The major CVD groups were coronary heart disease (CHD), cerebrovascular diseases (STROKE) and other heart diseases of uncertain etiology (HDUE).
Results:
Death rates from CHD were higher in countries with high serum cholesterol levels (USA, Finland and The Netherlands) and lower in countries with low cholesterol levels (Italy, Greece and Japan), but the opposite was observed for STROKE and HDUE, which became the most common CVD mortalities in all countries during the last 20 years of follow-up. Systolic blood pressure and smoking habits were, at an individual level, the common risk factors for the three groups of CVD conditions, while serum cholesterol level was the most common risk factor only for CHD. Overall, death rates for the pooled CVDs were 18% higher in North American and Northern European countries, while CHD rates were 57% higher in the same countries.
Conclusions:
Differences in lifelong CVD mortalities across different countries were smaller than expected due to the different rates of the three groups of CVD, and the indirect determinant of this seemed to be baseline serum cholesterol levels.
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