Abstract
This analysis aims at describing all-cause mortality and their determinants in 16 cohorts of middle-aged men of eight nations. A total of 12,763 men aged 40–59 years were enrolled in the late 1950s and early 1960s in 16 cohorts located in the USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan. The highest death rates were found in Slavonia–Croatia, due to high rates of infectious diseases and violence (death rate of 610 per 1000), and in East Finland due to high rates from coronary heart disease (death rate of 597 per 1000). The lowest death rates were found in a highly educated group in Belgrade, Serbia (death rate 295 per 1000) and in Crete, Greece (death rate 314 per 1000). The ecological analysis showed no significant relationship between mean risk factor levels and all-cause death rates except for the direct association with systolic blood pressure during the first 15 years follow-up. Individual multivariate analysis on eight national pools showed that age, systolic blood pressure, and smoking habits are direct, significant, and universal long-term predictors of all-cause mortality. Serum cholesterol, physical activity and body mass index were so only in some areas. Multivariate coefficients were similar across nations. Pooled hazards ratios were 1.55 for a difference of 5 years of age (CI: 1.51–1.59); 1.23 for 10 cigarettes smoked per day (CI: 1.20–1.26); 0.91 for one unit (based on three grades) of physical activity score (CI: 0.87–0.95); 1.04 for 1 mmol/l of serum cholesterol (CI: 1.02–1.07); and 0.93 for three units of body mass index (CI: 0.91–0.96). In conclusion some cardiovascular risk factors predict long-term risk of all-cause mortality in different cultures.
Similar content being viewed by others
References
Keys A (ed). Coronary heart disease in seven countries. Circulation 1970; 41:(Suppl 1): 1–211.
Keys A (ed). Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge (MA): Harvard University Press, 1980, pp. 1–381.
Menotti A, Keys A, Kromhout D, et al. Inter-cohort differences in coronary heart disease mortality in the 25-year follow-up of the Seven Countries Study. Eur J Epidemiol 1993; 9: 527–536.
Menotti A, Keys A, Blackburn H, et al. Comparison of multivariate predictive power of major risk factors for coronary heart disease in different countries: Results from eight nations of the Seven Countries Study, 25-year follow-up. J Cardiov Risk 1996; 3: 69–75.
Menotti A, Jacobs DR, Blackburn H, et al. Twenty-five-year prediction of stroke deaths in the Seven Countries Study. The role of blood pressure and its changes. Stroke 1996; 27: 381–387.
Menotti A, Blackburn H, Kromhout D, et al. The inverse relation of average population blood pressure and stroke mortality rates in the seven countries study: A paradox. Eur J Epidemiol 1997; 13: 379–386.
Ocke MC, Bueno-de-Mesquita HB, Feskens EJ, et al. Adherence to the European code against cancer in relation to long-term cancer mortality: Intercohort comparisons from the Seven Countries Study. Nutr Cancer 1998; 30: 14–20.
Verschuren WMM, Jacobs DR, Bloemberg BPM, et al. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the Seven Countries Study. JAMA 1995; 274: 131–136.
Van den Hoogen PCW, Feskens EJM, Nagelkerke NJD, et al. The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. N Eng J Med 2000; 342: 1–8.
Visscher TL, Seidell JC, Menotti A, et al. Underweight and overweight in relation to mortality among men aged 40–59 and 50–69 years: The Seven Countries Study. Am J Epidemiol 2000; 151: 660–666.
Jacobs D Jr, Adachi H, Mulder I, et al. Cigarette smoking and mortality risk. Twenty-five-year follow-up of the Seven Countries Study. Arch Intern Med 1999; 159: 733–740.
Rose G, Blackburn H. Cardiovascular Survey Methods. Geneva: WHO, 1968.
Anderson JT, Keys A. Cholesterol in serum and lipoprotein fractions: Its measurement and stability. Clin Chem 1956; 2: 145–159.
WHO. International Classification of Diseases. 8th Revision. Geneva: WHO, 1975.
Cox DR. Regression models and life tables. J R Stat Soc 1972; B43: 187–220.
Dyer AR. A method for combining results from several prospective epidemiologic studies. Stat Med 1986; 5: 303–317.
Mulder I, Jansen MCJF, Smit HA, et al. Role of smoking and diet in the cross-cultural variation in lung cancer mortality. The Seven Countries Study. Int J Cancer 2000; 88: 665–671.
Menotti A, Conti S, Giampaoli S, et al. Coronary risk factors predicting coronary and other causes of death in 15 years. Acta Cardiol 1980; 35: 107–120.
Menotti A, Mariotti S, Seccareccia F, et al. The 25 year estimated probability of death from some specific causes as a function of twelve risk factors in middle aged men. Eur J Epidemiol 1988; 4: 60–67.
Keys A, Aravanis C, Blackburn H, et al. Serum cholesterol and cancer mortality in the Seven Countries Study. Am J Epidemiol 1985; 121: 870–883.
Menotti A, Lanti M, Seccareccia F, et al. Serum cholesterol and cancer: The Italian epidemiological experience. Nutr Metab Cardiov Dis 1991; 1: 189–194.
Conti S, Farchi G, Menotti A. Coronary risk factors and excess mortality from all causes and specific causes. Int J Epidemiol 1983; 12: 301–307.
Kannel WB, Neaton JD, Wentworth D, et al. Overall and coronary heart disease mortality rates in relation to major risk factors in 325,348 men screened for the MRFIT. Am Heart J 1986; 112: 825–836.
Stamler J, Dyer AR, Shekelle RB, et al. Relationship of baseline major risk factors to coronary and all-cause mortality, and to longevity: Findings from long-term follow-up of Chicago cohorts. Cardiology 1993; 82: 191–222.
Lowe LP, Greenland Ph, Ruth KJ, et al. Impact of major cardiovascular disease risk factors, particularly in combination on 22-year mortality in women and men. Arch Intern Med 1998; 158: 2007–2014.
Hoes AW, Grobbee DE, Valkenburg HA, et al. Cardiovascular risk factors and all-cause mortality: A 12 year follow-up study in The Netherlands. Eur J Epidemiol 1993; 9: 285–292.
Kornitzer M, Dramaix M, Beriot I, et al. Twenty-five-year mortality follow-up in the Belgian Bank Study. Cardiology 1993; 82: 153–171.
Lindsted KD, Tonstad S, Kuzma JW. Self-report of physical activity and patterns of mortality in Seventh-Day Adventist men. J Clin Epidemiol 1991; 44: 355–364.
Goldberg RJ, Larson M, Levy D. Factors associated with survival to 75 years of age in middle-aged men and women. Arch Intern Med 1996; 156: 505–509.
Selmer R. Blood pressure and twenty-year mortality in the city of Bergen, Norway. Am J Epidemiol 1992; 136: 428–440.
West RR. Smoking: Its influence on survival and causes of death. J R Coll Physicians London 1992; 26: 357–366.
Kronmal RA, Cain KC, Ye Z, et al. Total serum cholesterol levels and mortality risk as a function of age. A report based on the Framingham data. Arch Intern Med 1993; 153: 1065–1073.
Neaton JD, Blackburn H, Jacobs D, et al. Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factors Intervention Trial. MRFIT Research Group. Arch Intern Med 1993; 152: 1490–1500.
Smith GD, Shipley MJ, Marmot MG, et al. Plasma cholesterol concentration and mortality. The Whitehall Study. JAMA 1992; 267: 70–76.
Keys A. Longevity of man: Relative weight and fatness in middle age. Ann Med 1989; 21: 163–168.
Menotti A, Descovich GC, Lanti M, Spagnolo A, Dormi A, Seccareccia F. Indexes of obesity and all-causes mortality in Italian epidemiological data. Prev Med 1993; 22: 293–303.
Seccareccia F, Lanti M, Menotti A, Scanga M. Role of body mass index in the prediction of all cause mortality in over 62,000 men and women. The Italian RIFLE Pooling Project. J Epidemiol Comm Health 1998; 52: 20–26.
D'Agostino RB, Belanger AJ, Kannel WB, et al. Role of smoking in the U-shaped relation of cholesterol to mortality in men. The Framingham Study. Am J Epidemiol 1995; 141: 822–827.
Weyerer S. Effects of physical inactivity on all-cause mortality risk in Upper Bavaria. Perc Motor Skills 1993; 77: 99–505.
Sandvik L, Erikssen J, Thaulow E, et al. Physical fitness as a predictor of mortality among healthy middle-aged Norwegian men. New Engl J Med 1993; 328: 533–537.
Leon AS, Connett J. Physical activity and 10.5 year mortality in the Multiple Risk Factor Intervention Trial (MRFIT). Intern J Epidemiol 1991; 20: 690–697.
Paffenbarger RS Jr, Jung DL, Jung RW, et al. Physical activity and hypertension: An epidemiological view. Ann Med 1991; 23: 319–327.
Ford ES, DeStefano F. Risk factors for mortality from all causes and from heart disease among persons with diabetes. Findings from the National Health and Nutrition Examination Survey. I. Epidemiologic follow-up study. Am J Epidemiol 1991; 133: 1220–1230.
Clay CM, Dyer AR, Liu K, et al. Education, smoking and non-cardiovascular mortality: Findings in three Chicago epidemiological studies. Intern J Epidemiol 1988; 17: 341–347.
Davey-Smith G, Neaton JD, Wentworth D, et al. Socioeconomic differential in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. white men. Am J Public Health 1996; 86: 486–496.
Tsevat J, Weinstein MC, Williams LM, et al. Expected gains in life expectancy from various coronary risk factor modifications. Circulation 1991; 84: 1194–1201.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Menotti, A., Blackburn, H., Kromhout, D. et al. Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study. Eur J Epidemiol 17, 337–346 (2001). https://doi.org/10.1023/A:1012757616119
Issue Date:
DOI: https://doi.org/10.1023/A:1012757616119