Mortality Time-Trends of Different Cardiovascular Diseases in a Practically Extinct Cohort of Italian Middle-Aged Men...

Area of Science:

• Cardiovascular epidemiology
• Longitudinal cohort studies
• Risk factor analysis

Background:

• Cardiovascular diseases (CVD) represent a major global health burden.
• Understanding the natural history and risk factors of specific CVD mortality categories is crucial for targeted prevention.
• Previous studies have often grouped diverse CVD outcomes, potentially obscuring important differences.

Purpose of the Study:

• To investigate the long-term natural history of major cardiovascular disease mortality categories in a male Italian cohort.
• To examine the relationships between baseline risk factors, particularly serum cholesterol, and mortality from coronary heart disease (CHD), stroke, and other heart diseases of uncertain etiology (HDUE).
• To assess differences in risk factor profiles and disease trajectories among these CVD categories.

Main Methods:

• A 61-year longitudinal study of 1712 Italian men, initially aged 40-59.
• Utilized Cox and Fine-Gray models to analyze mortality data and risk factor associations.
• Examined 12 baseline covariates, including serum cholesterol levels, as predictors of CVD mortality.

Main Results:

• Coronary heart disease (CHD) mortality declined over the follow-up period, while HDUE mortality showed a sharp increase.
• Serum cholesterol was a significant positive predictor for CHD and stroke mortality, but not for HDUE.
• Fine-Gray models indicated opposing effects of cholesterol on CHD versus other CVD mortality categories.

Conclusions:

• Significant differences exist in the natural history and risk factor associations among CHD, stroke, and HDUE mortality.
• These findings suggest distinct etiologies for these CVD categories, underscoring the importance of analyzing them separately rather than as a combined CVD group.