Is Italy losing the “Mediterranean advantage?” Report on the Gubbio population study: Cardiovascular risk factors at baseline

Abstract

The coronary heart disease mortality rate in Italy—lower than in many other industrialized countries—has changed little in the last 20 years, whereas in the United States, a major decline in deaths resulting from coronary heart disease has occurred. These differing trends have reduced considerably the gap between the two countries in coronary mortality rates. Several recent population studies in Italy have found a change in the previously more favorable risk factor profile. In the northern hill town of Gubbio, studied in 1983–1985, median serum cholesterol level of men ages 40–59 was 223 mg/dl, considerably higher than was found in the 1960 Italian population samples of the Seven Countries Study (197–206 mg/dl). In the earlier study, the cholesterol levels in the Italian men who were still mainly consuming the traditional Mediterranean diet were 30–40 mg/dl lower than in the U.S. sample. The 1980 Gubbio levels, however, were at least as high as those of their U.S. contemporaries. Cigarette smoking was much higher among the middle-aged men of Gubbio than among a similar U.S. population sample (56% vs 36%). Hypertension prevalence was high, and several risk factors for hypertension—obesity, high salt intake, and alcohol—were common in the Gubbio as well as in other recent Italian population studies. The changing coronary risk profile in Italy, which now includes higher population levels of serum cholesterol as well as the other major coronary heart disease risk factors of cigarette smoking and hypertension, threatens to reduce markedly the “Mediterranean advantage” enjoyed by Italy in the past.