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Background: Studies on the association between depressive symptomatology (DS) and cardiovascular events and mortality in elderly persons have yielded contradictory findings. To address this issue, the authors assessed DS and an extensive array of sociodemographic, behavioral, and biological variables in the largest population-based sample of older Italians ever studied and analyzed their association with coronary heart disease (CHD) morbidity and total number of deaths., Methods: This prospective, community-based cohort study included a sample of 5632 Italians, 65 years and older, who were recruited from the demographic registries of eight municipalities in Italy. Depressive symptomatology was assessed using the Geriatric Depression Scale, and a score > or =10 was used to indicate the presence of DS. All traditional cardiovascular disease risk factors were assessed at baseline, through questionnaires, blood tests, and physical examinations. The outcomes were CHD fatal and nonfatal events and total number of deaths. The association of the predictive variables with the outcomes was assessed using different Cox models., Results: Baseline DS was associated with a higher incidence of fatal and nonfatal CHD events (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.06-2.60) and with cardiovascular mortality in men (HR, 2.49; 95% CI, 1.60-3.87) and with total mortality in men (HR, 2.02; 95% CI, 1.58-2.58) and women (HR, 1.43; 95% CI, 1.04-1.95) at the 4-year follow-up assessment. This association was observed after adjusting for a vast array of potential confounding variables, including major chronic conditions., Conclusions: Depressive symptomatology confers an increased risk for CHD in men and for total mortality in men and women but is not explained by health behaviors, social isolation, or biological or clinical determinants.

Background: To examine the association between established coronary heart disease (CHD) risk factors and eating patterns by creating a dietary index utilizing a limited amount of food frequency questionnaire data on specified indicator foods., Methods: Selected data from the Italian Risk Factors and Life Expectancy (RIFLE) project collected between 1978-1979 and 1983-1984 on 7665 men and women, aged 20-59 years, were used to compute a dietary index summarizing the relative proportion of fatty to non-fatty foods. The association between this index and systolic and diastolic blood pressure (SBP, DBP), body mass index, total serum cholesterol (TC), and blood glucose, controlling for potential confounders was then tested using multiple linear regression., Results: Among men, a positive association was found between the index and all five CHD risk factors (P < 0.01). Among women, the associations were weaker, becoming statistically significant only for TC and glucose., Conclusions: Our food index was able to detect relationships between diet and traditional CHD risk factors. A tool such as this, which requires only a limited number of key indicator food items, might enhance the use of existing food frequency questionnaires and also streamline the process of collecting new dietary information.

Background: Few risk functions for the prediction of coronary heart disease mortality have been produced in Italy. This study used a large population sample to evaluate the effect of major risk factors on coronary mortality., Methods: Coronary deaths in 45 cohorts of men (n = 31317, aged 30-69 years) were studied and related to selected cardiovascular risk factors., Results: After 6 years, 1089 men had died, of whom 239 were coronary fatalities. Univariate and multivariate (Cox model) analyses conducted on each age group (30-39, 40-49, 50-59, and 60-69 years) showed a positive association between coronary deaths and systolic blood pressure, serum cholesterol level and cigarette smoking, with few exceptions. A multiple logistic model was produced for men aged 35-57 years, assessing the role of age, serum cholesterol, cigarettes smoked per day and diastolic instead of systolic blood pressure, using the same endpoint as that employed in a similar model published from the analysis of MRFIT primary screenees in the USA to facilitate valid comparison. The coefficients in the present study were similar to those in the US cohort: no statistically significant differences could be detected when comparing the pairs of coefficients., Conclusion: Coefficients relating cholesterol, blood pressure and cigarette smoking to coronary mortality in Italian men are similar to those in American men from the same age groups.

The multiple logistic function (MLF) was applied for the estimation of coronary heart disease (CHD) - "hard criteria" in 5 years as a function of several risk factors in two rural Italian areas belonging to the "Seven Countries Study". CHD was estimated with solutions including 4, 5 and 11 factors respectively. Only serum cholesterol showed a statistically significant contribution; but other factors, like age and physical activity, very likely contributed to a better discrimination between "cases" and "non-cases". By increasing the number of factors the discrimination tends to improve anyway. In the solution with 11 factors, 46% of the observed cases was found in the upper 10% of the estimated risk probabilities; 57% in the upper 20%; while no cases were found in the lowest 20% of the same rank probability list. For practical purposes of selecting high risk individuals for preventive action, a simple 5 factor solution, including age, systolic blood pressure, serum cholesterol, consumption of cigarettes and physical activity is suggested.

Data from two Italian rural cohorts of the Seven Countries Study are used to examine the relationship between level at entry to the study of some coronary risk factors and subsequent mortality. The target follow-up period of 15 years after entry to the study is complete. Causes of death are classified according to standard criteria and age-adjusted rates are calculated. The analysis shows that blood pressure and smoking are risk factors that explain a substantial amount of total mortality, whereas serum cholesterol seems to be a specific risk factor for coronary mortality. The excess risks of death attributable to blood pressure, smoking, serum cholesterol and also the estimated risk of death are reported.

European cohorts of the Seven Countries Study have been analyzed in order to examine relationships between the observed incidence of coronary heart disease (CHD) in the second 5-year period of the follow-up and the major risk factors and their spontaneous changes in the first 5 years. The analysis, using the Multiple Logistic Function (MLF) model, shows that changes of systolic blood pressure and smoking habits were significant factors associated with CHD incidence, whereas changes of cholesterol and body mass index were not.

Examinations of 'healthy' men in Helsinki and in rural west and east Finland in 1956 included estimation of total cholesterol and that in the HDL and beta fractions separated by electrophoresis. Vital status to the end of 1980 has been ascertained for all but eight of the 526 men aged 35-61 and for all but two of 261 men aged 30-34 at entry. Among the men aged 35-61, in 24 years 155 died, 63 from coronary heart disease; among the men aged 30-34, 36 died, 16 from coronary heart disease. All causes and coronary death rates were highest in east Finland where HDL cholesterol was also highest. Coronary death rates were not related to HDL cholesterol in east or west Finland but 16 men dead from coronary heart disease in Helsinki tended to have low HDL values. Consideration of five other entry characteristics did not change the picture with regard to HDL-mortality relationships. Solution of the multiple logistic equation using all those variables found the probability of 24-year coronary death was not significantly related to HDL but was significantly related, positively, to the non-HDL cholesterol concentration. HDL and total cholesterol mean values for men of the same age in the same area of Finland, with lipoprotein separation by the new recommended methods, agree closely with the means recorded in 1956. These 24-year findings are not necessarily in conflict with reports in the literature on an inverse relationship between coronary heart disease incidence and HDL cholesterol based on much shorter periods of follow-up and few data on mortality.

Some risk functions are presented linking serum cholesterol to the development of coronary heart disease. They are produced from epidemiological studies on Italian population samples made of men aged 40-59 at entry and followed up to 20 years. The purpose is to provide a simple tool for the estimation of the expected risk and of that depending on changes of the risk factor.

The analysis concerns the two rural Italian cohorts of the Seven Countries Study and includes 1,712 men who, at the entry examination in 1960, were aged 40-59 years and whose 20-year follow-up examinations were complete for life status, dates, and causes of death. Excluded were 175 men because they lacked one or more of the risk factors selected for the study. A total of 517 deaths occurred in the remaining 1,537 men. The Cox proportional hazards regression model was applied with a forward procedure to include the entry risk factors in the model. First, total mortality was used as the endpoint. Then the risk factors identified as being related to total mortality were used to predict specific causes of death, i.e., coronary heart disease, stroke, cancer, violent death, and other causes. Blood pressure appeared as a nonspecific risk factor for all causes, including cancer and violence, forced expiratory volume and arm circumference appeared as nonspecific risk factors, smoking habits could not be easily classified, and cholesterol was definitely specific only for coronary deaths. Models for estimating survival probabilities from total mortality and from any of several causes of death are provided.

Data from the Seven Countries Study are analysed to examine the relationship between the observed incidence of Coronary Heart Disease in the second 5-year period of follow-up and the major entry risk factors and their changes over the first 5 years. The analysis, using the Multiple Logistic Function model, shows that changes in systolic blood pressure and smoking habits are significant factors associated with incidence, while changes in cholesterol and body mass index do not play this role. This conclusion applies to the population as a whole. A more detailed analysis, stratifying the population by estimated risk at entry and changes of risk over 5 years, shows that incidence is related to changes of risk in low and medium entry risk groups. Moreover, a univariate analysis of data limited to systolic blood pressure and cholesterol indicates that changes in blood pressure are related to incidence in the group with highest entry level of blood pressure, while changes in cholesterol are irrelevant to subsequent incidence.

In the Roman Project of Coronary Heart Disease Prevention two different techniques were employed for the identification of individuals at high coronary risk within the treatment groups of the Project. The "risk score" is a simple additive system developed by the working groups of WHO, while the "multiple logistic function" is a complex mathematical model of multivariate analysis. Both of them consider 5 risk factors (age, systolic blood pressure, serum cholesterol, smoking habits and physical activity at work) and are applied for the identification of individuals belonging to the upper 20% of a risk rank list. The two techniques apparently provide similar predictive performances when applied to epidemiological prospective material collected in other studies where the morbid events are already known. When employed in the study population groups they identify, as high risk individuals, different subgroups of population, which overlap only partially. On the basis of theoretical and practical considerations, it has been decided to employ both techniques and to extend, as a consequence, the proportion of high risk individual, eligible for individual treatment, from 20% to about 30% of the total.

The hypotheses of reversibility of risk and of prevention of increasing risk represent the theoretical basis for any attempt to prevent coronary heart disease. After the impressive but inconclusive trials of the first generation, conducted principally in the sixties and on single risk factors, the second-generation trials, begun in the seventies and focused mainly on multifactor intervention, are now producing preliminary results. Although many problems remain unresolved and many questions are as yet unanswered, several results indicate the feasibility of mass intervention aimed at changing the risk-factor levels and suggest an association of such action with a measurable reduction in the incidence of coronary heart disease.

The effects of three major risk factors (i.e. serum cholesterol, systolic blood pressure and smoking habits) on prediction of coronary heart disease (CHD) mortality in relation to three nuisance variables--i.e. geographical location, age of subject at examination and period of examination--are analyzed using data from three different 5-year apart examinations of the Seven Countries Study and observations on CHD mortality in the corresponding 15-year follow-up period. First, a cross-classification exploratory analysis including both CHD-free subjects at entry and prevalence subjects, by different geographical areas, age classes and examination times is presented. Secondly, a logistic regression including the three major risk factors and the three nuisance variables, regarded both as confounders and effect modifiers is discussed. The prevalence status of the subjects is also considered as a nuisance variable in this second analysis. Results showed that: (a) there is a highly significant (p less than 0.001) marked decrease in the association between cholesterol level and CHD mortality with increasing age of subject; (b) a decreasing association with coronary heart disease mortality as age increases also holds for smoking habits (p less than 0.05). This association, however, tends to be reinforced with time (p less than 0.05), i.e. the relative risk of heavy smokers vs non-smokers is four times bigger in the period 1970-75, than in the period 1960-65, age and all other factors being equal; (c) a possible dependence of the association between systolic blood pressure and CHD on geographical area is suggested, although this finding could be the result of chance with a 10% probability.