Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study

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.