Twenty-five-year cardiovascular disease incidence among middle-aged men. Disease burden, time shape, predictors, risk probabilities.
BACKGROUND
This analysis aims at describing the 25-year experience in cardiovascular incidence in a sample of middle-aged men in rural Italy.


METHODS
A total of 1712 men aged 40-59 years were examined in 1960 in two rural Italian cohorts belonging to the Seven Countries Study. Major risk factors were measured and a monitoring system for incidence of cardiovascular events was in operation for the next 25 years centered on the first event occurring within each subgroup of cardiovascular diseases. Data were modeled by the Weibull distribution incorporated in the accelerated failure time model.


RESULTS
Among 1695 cardiovascular disease-free men at entry, 51.3% experienced at least one cardiovascular event, the first being a coronary heart disease (35.6%), a cerebrovascular disease (17.8%) or a peripheral artery disease (13.0%). Among all first events the most common was intermittent claudication (17.6%), followed by angina pectoris (16.6%). A proportion of 13% of all initial episodes was rapidly fatal, whereas 38 % of subjects developing a cardiovascular event died within the 25-year deadline. Age, cigarette smoking, diabetes, corneal arcus, serum cholesterol, systolic blood pressure, and vital capacity fed into the accelerated failure time model showed a statistically significant association with cardiovascular disease incidence (inverse for vital capacity). The same model provided the shape of hazard during the 25 years with major events continuing to appear in an increasing exponential fashion, while soft criteria events were less likely to appear as a first event in the late phase of follow-up.


CONCLUSIONS
In middle-aged men 25-year incidence of cardiovascular diseases is high and more relevant compared to that of traditional hard criteria coronary heart disease that in the past has attracted almost exclusive interest.
Menotti
A
A
Division of Epidemiology, University of Minnesota, Minneapolis, USA.
Lanti
M
M
Puddu
P E
PE
D000328:Adult; D000367:Age Factors; D000787:Angina Pectoris / Q000453:epidemiology; D001112:Arcus Senilis; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D048909:Diabetes Complications; D005500:Follow-Up Studies; D006801:Humans; D007383:Intermittent Claudication / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012424:Rural Population; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013599:Systole; D013997:Time Factors; D014797:Vital Capacity
D002784:Cholesterol