Prevention of Coronary Heart Disease: Diet, Lifestyle and Risk Factors in the Seven Countries Study

In the 1940s I was struck by reports about many apparently healthy middle-aged men who dropped dead instantly from heart attacks. The causes of these sudden deaths were unknown. I was interested to discover physio-chemical characteristics of individuals with predictive value for the occurrence of these fatal heart attacks. The discovery ofpreventive variables would point ways to prevent this disease. In order to find relationships between mode of life and susceptibility to heart disease contrasting populations had to be studied. Variety - not a high degree of homogeneity in culture and habits - must be sought. After exploratory surveys in countries with supposed differences in dietary patterns, lifestyle and heart disease rates in the early 1950s, the Seven Countries Study took off in 1958. This study established relationships between risk factors and development of heart disease in middle-aged men in health examined in countries with cultures we demonstrated to contrast in diet and lifestyle. The results obtained in the Seven Countries Study from its inception till now are presented in this book entitled: "Prevention ofcoronary heart disease. Diet, lifestyle and risk factors in the Seven Countries Study. " Long ago I realized that our concern should not be restricted to the prevention of coronary heart disease but should be extended to all diseases and premature death.

Klappentext
The Seven Countries Study was the first to establish credible data on incidence and death rates of CHD in contrasting cultures. The study documented population differences in average levels and distributions of coronary risk factors. It also demonstrated large differences in composition of the diet in otherwise similar, stable, rural agricultural or pastoral populations. Diet and cigarette smoking explained most of the differences in population CHD rates, while changes in serum cholesterol and blood pressure levels between entry and 25-year follow-up examinations explained much of the change in CHD death rates. Results of the Seven Countries Study were crucial to the concept of population causes, that is, the mass phenomena involved in the genesis of coronary heart disease, and which influence widespread individual and species susceptibility. Where environments are unfavourable one finds maximal exhibition of coronary risk and a heavy population disease burden. Where favourable, individual (genetic) susceptibility is attenuated. This concept developed from the Seven Countries study design that combined, for the first time, a population and an individual approach. The study was realised trough effective collaboration established among clinicians, epidemiologists and nutritionists from Europe, the U.S.A., and Japan. Implications: The Seven Countries Study has played a central role in the population strategy of heart disease prevention and health promotion, complementing traditional medical strategies. It contributed to the notion that major risk factors universally predict individual risk. Cultures as well as individuals were found to differ greatly in absolute risk of a coronary event at any level of single or combined risk factors, presumably due to different duration of risk exposure, different gene-environment interactions, and to factors not yet known. Intervention strategy is therefore best determined by absolute risk. Finally, the medical, public health, and nutrition community, as well as agribusiness internationally, have been profoundly influenced by the Seven Countries Study in their recommendations, toward more healthy eating patterns.

Zusammenfassung
After exploratory surveys in countries with supposed differences in dietary patterns, lifestyle and heart disease rates in the early 1950s, the Seven Countries Study took off in 1958.

Inhalt
1. Part I: Background and the burden of cardiovascular diseases.- 1.1. Objectives and history of the Seven Countries Study.- 1.2. Populations and organization of the surveys in the Seven Countries Study.- 1.3. Prevalence and incidence of cardiovascular diseases in the Seven Countries Study.- 1.4. Cardiovascular and all-causes mortality patterns in the Seven Countries Study.- 2 Part II: Diet, lifestyle and coronary heart disease.- 2.1. Diet and coronary heart disease in the Seven Countries Study.- 2.2. Diet and coronary heart disease in the Zutphen Study.- 2.3. Cigarette smoking, coronary heart disease and all-causes mortality in the Seven Countries Study.- 2.4. Alcohol and coronary heart disease in the Seven Countries Study.- 2.5. Physical activity, physical fitness and coronary heart disease in the Seven Countries Study.- 3 Part III: Biological risk factors and coronary heart disease.- 3.1 Serum cholesterol and coronary heart disease in the Seven Countries Study.- 3.2 Blood pressure and cardiovascular diseases in the Seven Countries Study.- 3.3 Body fatness, coronary heart disease and all-causes mortality in the Seven Countries Study.- 3.4 Type 2 diabetes, glucose tolerance and cardiovascular diseases in the Seven Countries Study.- 3.5 Electrocardiographic predictors of coronary heart disease in the Seven Countries Study.- 3.6 Multivariate analysis of major risk factors and coronary risk in the Seven Countries Study.- 4 Part IV: Implications of findings of the Seven Countries Study.- 4.1 Risk factors for global coronary risk in preventive and clinical cardiology.- 4.2 Diet, lifestyle and prevention of coronary heart disease The integration of observational and experimental evidence.- 4.3 Epilogue for the Seven Countries Study.

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