Lifestyle behaviours predicting major cardiovascular diseases mortality in a practically extinct cohort of middle-aged men followed-up for 61 years

Abstract

To study lifetime relationships of three major lifestyle behaviours with cardiovascular mortality in a cohort of middle-aged men that reached practical extinction. In the Italian Areas of the Seven Countries Study of Cardiovascular Diseases (SCS), 1712 men were enrolled and examined in 1960, and behavioural habits were measured: smoking habits, physical activity and diet each divided into three classes. Follow-up for mortality was extended for 61 years. Three groups of major cardiovascular diseases (CVD) were used for analysis, coronary heart disease (CHD), STROKE and other Heart Diseases of Uncertain Aetiology (HDUE). Kaplan–Meier curves, death rates in classes of behaviours and Cox proportional hazard models were computed, the last ones adjusted for other major risk factors. In 61 years of follow-up, 1708 men died and 727 were cases of CVD as defined above. Clear separation of classes in Kaplan–Meier survival curves were seen only for physical activity and diet in CHD, and physical activity for STROKE. Cox proportional hazard ratios (HR, adjusted for age, blood pressure and serum cholesterol) showed the significant protective effect on CHD of Mediterranean diet (HR = 0.72), vigorous physical activity (0.55), never smoking (0.73); on STROKE of vigorous physical activity (0.67); on HDUE of never smoking (0.57). Combination of three healthy versus three unhealthy behaviours was associated for CHD to a lower mortality of 39%. This comparison was not coherent for STROKE and HDUE. Lifetime healthy behaviours are clearly beneficial versus CHD mortality but not necessarily for mortality from HDUE and STROKE that probably represent different morbid conditions.