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Role of socioeconomic indicators in the prediction of all causes and coronary heart mortality in over 12,000 men. The Italian RIFLE pooling project.
No full textElectrocardiographic Minnesota Code findings predicting short term mortality in asymptomatic subjects. The Italian RIFLE Pooling Project
No full textPresentation of the RIFLE Project Risk Factors and Life Expectancy
No full textPlans are presented for conducting an epidemiological observational project which will pool the data from nine Italian field studies covering over 70,000 men and women aged 20 to 69 years, belonging to 52 population samples distributed in 13 different regions of the country. The main objective is to produce multivariate models for the prediction of all-cause mortality, life expectancy and selected causes of death as a function of some baseline characteristics. The entry examinations of the population samples were performed between 1978 and 1987 with the measurements of risk factors and other personal characteristics mainly related to cardiovascular diseases and other chronic conditions. They include a large number of anthropometric, social, biochemical, biophysical, clinical, nutritional and behavioural measurements, although only a limited subset of them is common to all the studies. The collection of data on life status, mortality and causes of death has already been completed for 45 out of the 52 samples, although for lengths of follow-up varying from 4 to 12 years. The systematic analysis of this data bank will be started in 1993
Epidemiology of heart disease of uncertain etiology: A population study and review of the problem
No full textBackground and objectives: Previous epidemiological studies have identified a group of heart diseases (here called heart diseases of uncertain etiology—HDUE) whose characteristics were rather different from cases classified as coronary heart disease (CHD), but frequently confused with them. This analysis had the purpose of adding further evidence on this issue based on a large population study. Materials and Methods: Forty-five Italian population samples for a total of 25,272 men and 21,895 women, free from cardiovascular diseases, were examined with measurement of some risk factors. During follow-up, CHD deaths were those manifested as myocardial infarction, other acute ischemic attacks, and sudden death of probable coronary origin, after reasonable exclusion of other causes. Cases of HDUE were those manifested only as heart failure, chronic arrhythmia, and blocks in the absence of typical coronary syndromes. Cox proportional hazards models were computed separately for CHD and HDUE, with 11 risk factors as possible predictors. Results: During an average of 7.4 years (extremes 1–16) there were 223 CHD and 150 HDUE fatal events. Male sex, age, smoking habits, systolic blood pressure, serum cholesterol, and plasma glucose were significantly and directly related to CHD events, while high density lipoprotein (HDL) cholesterol was so in an inverse way. The same risk factors were predictive of HDUE events except serum cholesterol and HDL cholesterol. Multivariable hazards ratio of serum cholesterol (delta = 1 mmol/L) was higher in the CHD model (1.24, 95% CI 1.11–1.39) than in the HDUE model (1.03, 0.5% C.I. 0.89–1.19) and the difference between the respective coefficients was statistically significant (p = 0.0444). Age at death was not different between the two end-points. Conclusions: CHD and HDUE are probably two different morbid conditions, only the first one is likely bound to gross atherosclerotic lesions of coronary arteries and linked to blood lipid levels. We reviewed the problem in epidemiological investigations and addressed inflammation as a potential cofactor to differentiate between CHD and HDUE
The prediction of coronary heart disease mortality as a function of major risk factors in over 30.000 men in the italian RIFLE Pooling Project. A comparison with the MRFIT primary screenees
No full textBACKGROUND: 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
Role of socioeconomic indicators in the prediction of all causes and coronary heart disease mortality in over 12,000 men ± The Italian RIFLE pooling project
No full textThe relationship of socioeconomic indica-
tors (education, occupation and residence) to short-
term all cause mortality and coronary heart disease
(CHD) mortality was evaluated in an Italian popu-
lation sample. Socioeconomic indicators (education,
occupational level and residence) and major CHD
risk factors were measured in 12,361 males aged 40±
69 years; mortality data by cause were collected for
the next 6 years. All cause and CHD mortality risk
ratio (RR) in the di erent educational and occupa-
tional levels and residence were computed by Cox
proportional hazards models. After 6 years 385 men
died, of whom 105 were coronary fatalities. No as-
sociation with educational level was found for all
cause mortality (RR: 1.00 high, 0.71 medium, 0.77
low) and for CHD mortality (RR: 1.00 high, 0.39
intermediate, 0.71 low). Occupational level was sig-
ni®cantly associated ( p < 0.031) with all cause
mortality (RR: 1.00 high-intermediate, 1.27 low).
Urban vs. rural residence (RR: 1.00) showed a RR
for all cause mortality of 1.33 ( p < 0.011). Adjust-
ment for bio-behavioral risk factors did not change
the above results; only mortality for CHD of urban
vs. rural residents increased (RR: 1.94, p = 0.004). In
conclusion the negative association of mortality with
occupational level, albeit not with education, indi-
cates that occupation is a better indicator of socio-
economic status in Italy. Status incongruity as well as
residence in an urban environment could be risk
conditions for total and CHD mortality
Syndrome X: Prevalence in a large population-based study
No full textMuch interest has been devoted to a cluster of metabolic abnormalities including impaired glucose metabolism, high blood pressure, low HDL cholesterol and high triglycerides, defined as Syndrome X, and its role as a potential important risk factor for cardiovascular disease. However, limited information exists about the prevalence of this cluster of metabolic abnormalities in population-based studies. A large cohort of men and women (24,798 men and 20,558 women), age 20-69, participants in a series of epidcmiological investigations, were pooled. Estimates of the prevalence of Syndrome X and the individual factors comprising this cluster of metabolic abnormalities were calculated according to gender and age gronps.The majority of participants at baseline presented one or more of the metabolic abnormalities, ie, elevated blood levels of glucose, triglycerides, high blood pressure, lower levels of high density lipoproteins. However, the prevalence of the full cluster (Syndrome X) of metabolic abnormalities was low in the population as a whole, with only 2.4% of men and 3.1% of women exhibiting the full Syndrome X. These data from a large population-based epidemiological investigation indicate that the presence of a full cluster of metabolic abnormalities from Syndrome X is limited. The majority of individuals present elevation in any one or two of the metabolic abnormalities. The notion of the cluster of metabolic abnormalities (Syndrome X) should not distract our attention from established individual risk factors that have been proven to be major causes of cardiovascular death and disability in our society. ©1997, Medikal Press
Role of body mass index in the prediction of all cause mortality in over 62 000 men and women. The Italian RIFLE Pooling Project
No full textStudy objective—To evaluate the relation
of body mass index (BMI) to short-term
mortality in a large Italian population
sample.
Design—Within the Italian RIFLE pooling
project, BMI was measured in 47 population
samples made of 32 741 men and
30 305 women aged 20–69 years (young
20–44, mature 45–69). Data on mortality
were collected for the next six years.
Main outcome measures—Age adjusted
death rates in quintile classes of BMI and
Cox proportional hazards models with six
year all causes mortality as end point,
BMI as covariate and age, smoking, systolic
blood pressure as possible confounders
were computed. Multivariate analysis was
tested in all subjects and after the exclusion
of smokers, early (first two years)
deaths, and both categories.
Results—The univariate analysis failed to
demonstrate in all cases a U or inverse J
shaped relation. The Cox coefficients for
the linear and quadratic terms of BMI
proved significant for both young and
mature women. The minimum of the
curve was located at 27.0 (24.0, 30.0, 95%
confidence limits, CL) and 31.8 (25.5, 38.2,
95% CL) units of BMI, for young and
mature women respectively. Similar findings
were obtained even when exclusion
were performed. No relation was found for
young men while for mature adult men
only the model for all subjects retained
significant curvilinear relation (minimum
29.3; 22.4, 36.2, 95% CL).
Conclusion—These uncommon high values
of BMI carrying the minimum risk of
death seems to be in contrast with weight
guidelines. A confirmation of these findings
in other population groups might
induce the consideration of changes in the
suggested healthy values of BMI
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