Dietary atherogenicity and thrombogenicity indexes predicting cardiovascular mortality: 50-year follow-up of the Seven Countries Study
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Updated: Jun 23, 2025
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Alessandro Menotti1, Paolo Emilio Puddu2, Johanna M Geleijnse3
1Association for Cardiac Research, Rome, Italy.
Insights
Dietary Atherogenicity Index (ATI) and Thrombogenicity Index (THI) strongly predict 50-year coronary heart disease (CHD) mortality. These indices did not significantly correlate with other heart diseases of uncertain etiology (HDUE) or stroke (STR) mortality.
Area of Science:
- Nutritional Epidemiology
- Cardiovascular Disease Research
- Public Health Nutrition
Background:
- Dietary patterns significantly influence cardiovascular health outcomes.
- Understanding the specific impact of dietary lipids on different cardiovascular diseases is crucial for targeted prevention strategies.
Purpose of the Study:
- To investigate the association between the Atherogenicity Index (ATI) and Thrombogenicity Index (THI) and 50-year mortality from coronary heart disease (CHD), other heart diseases of uncertain etiology (HDUE), and stroke (STR).
- To analyze these relationships across 16 international cohorts of middle-aged men.
Main Methods:
- Chemical analysis of fatty acids in foods from subsamples within the Seven Countries Study (SCS) cohorts.
- Calculation of ATI and THI for each cohort.
- Ecological correlation analysis between ATI/THI and mortality from CHD, HDUE, STR, and all-cause mortality at 25 and 50 years.
Main Results:
- Strong, significant positive correlations (Rs 0.79-0.97) were observed between ATI/THI and CHD mortality.
- No significant correlations were found between ATI/THI and HDUE or STR mortality.
- ATI and THI showed direct associations with all-cause mortality and dietary saturated fat/cholesterol, and inverse association with the Mediterranean Adequacy Index.
Conclusions:
- Coronary heart disease mortality is strongly linked to dietary lipid indices (ATI, THI), unlike HDUE and STR.
- The distinct relationships suggest that HDUE and STR may involve different etiological pathways or represent separate disease entities compared to CHD.
Background And Aim:
To study the relationships of an Atherogenicity Index (ATI) and a Thrombogenicity Index (THI), with 50-year mortality from coronary heart disease (CHD), other heart diseases of uncertain etiology (HDUE) and cerebrovascular disease or stroke (STR), in 16 international cohorts of middle-aged men.
Methods And Results:
Foods from a dietary survey in subsamples of men in each cohort of the Seven Countries Study (SCS) were chemically analyzed for several types of fatty acids that were converted into ATI and THI identifying each of 16 cohorts. Ecological correlations of the ATI and THI were calculated with the three fatal CVD conditions and with all-cause mortality at 25 and 50 years. Correlation coefficients (Rs) were positive and highly significant between ATI and THI versus CHD mortality, with levels ranging from 0.79 to 0.97, depending on the duration of follow-up and the choice of 10 or of 16 cohorts. This was not the case for HDUE and STR mortality for which Rs were variable and not significant. A strong direct association was also found with all-causes deaths at 25 and 50-years. ATI and THI were also directly related with dietary saturated fat and cholesterol levels and inversely with the Mediterranean Adequacy Index (a score identifying the Mediterranean diet).
Conclusion:
These findings indicate that CHD has a different relationship with dietary lipids intake than HDUE and STR. This suggests that HDUE and STR have different underlying pathways or are different diseases.
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