Menotti A, Seccareccia F, Blackburn H, Keys A
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA.
Int J Epidemiol. 1995 Jun;24(3):515-21. doi: 10.1093/ije/24.3.515.
Samples of railroad male employees aged 40-59 were examined from companies operating in the northwest quadrant of the US in the late 1950s (n = 2571), and in Rome and surroundings. Italy in the early 1960s (n = 768) in an international co-operative study on cardiovascular diseases.
A number of cardiovascular risk factors (age, blood pressure, serum cholesterol, body mass index, subscapular skinfold, physical activity, smoking habits) were measured at year 0 and year 5, while data on mortality and causes of death were collected for 25 years.
Coronary heart disease (CHD) death rates were always higher in the US than in Italy; after 25 years the excess was 51%. Cox proportional hazards models with CHD deaths as endpoint and seven CHD risk factors as covariates showed only the coefficients for age and smoking habits statistically different between the two cohorts. Changes in systolic blood pressure during the first 5-year follow-up were additional predictors of 5- to 25-year CHD mortality in both groups. Cholesterol plus age (greater in the US), subscapular skinfold (greater in the US) and body mass index (greater in Italy) 'explained' 67% of the observed differences in 25-year CHD mortality in the two cohorts.
A large proportion of differential CHD mortality can be attributed to some traditional risk factors.
20世纪50年代末，从美国西北象限运营的公司中选取了40 - 59岁的铁路男性员工样本（n = 2571），以及20世纪60年代初意大利罗马及其周边地区的样本（n = 768），用于一项关于心血管疾病的国际合作研究。
在第0年和第5年测量了一些心血管危险因素（年龄、血压、血清胆固醇、体重指数、肩胛下皮褶厚度、身体活动、吸烟习惯），同时收集了25年的死亡率和死亡原因数据。
美国的冠心病（CHD）死亡率一直高于意大利；25年后，这一差距为51%。以CHD死亡为终点、七个CHD危险因素为协变量的Cox比例风险模型显示，两组之间仅年龄和吸烟习惯的系数在统计学上存在差异。在两组中，前5年随访期间收缩压的变化是5至25年CHD死亡率的额外预测因素。胆固醇加年龄（美国更高）、肩胛下皮褶厚度（美国更高）和体重指数（意大利更高）“解释”了两组中观察到的25年CHD死亡率差异的67%。
很大一部分CHD死亡率差异可归因于一些传统危险因素。
