Tea consumption. relationship to cholesterol, blood pressure, and coronary and total mortality.

BACKGROUND AND METHODS. The relation of tea to cholesterol, systolic blood pressure, and mortality from coronary heart disease and all causes was studied in 9,856 men and 10,233 women without history of cardiovascular disease or diabetes. All men and women 35-49 years of age from the county of Oppland (Norway) were invited to participate; the attendance rate was 90%. RESULTS. Mean serum cholesterol decreased with increasing tea consumption, the linear trend coefficient corresponded to a difference of 0.24 mmol/liter (9.3 mg/dl) in men and 0.15 mmol/liter (5.8 mg/dl) in women between drinkers of less than one cup and those of five or more cups/day, when other risk factors were taken into account. Systolic blood pressure was inversely related to tea with a difference between the same two tea groups of 2.1 mm in men and 3.5 mm in women. Altogether 396 men and 237 women died from all causes, and of these 141 and 18, respectively, died from coronary heart disease during the 12-year follow-up period. The mortality rate was higher (not statistically significant) among persons drinking no tea or less than one cup compared with persons drinking one or more cups/day. This applies to men and women and to coronary heart disease and all-cause mortality. For men, the relative risk (one or more versus less than one cup) for coronary death from Cox regression was 0.64 (95% CI:0.38, 1.07).     

Total but not high-density lipoprotein cholesterol is consistently associated with coronary heart disease mortality in elderly men in Finland, Italy, and The Netherlands

We studied the relation between serum total and high-density lipoprotein (HDL) cholesterol and 10-year coronary heart disease mortality in elderly men in different European countries. The Finland, Italy and the Netherlands Elderly (FINE) Study is a prospective follow-up study in 2,132 elderly men ages 65-84 years in Finland, the Netherlands, and Italy. We estimated relative risks using Cox proportional hazard analysis with time-dependent covariates. Total cholesterol was positively related to coronary heart disease mortality in all three countries. The combined relative risk for the total population of the FINE Study was 1.17 (95% confidence interval = 1.06-1.29) for each 1.00 mmol/liter increase in total cholesterol. HDL cholesterol was inversely related to coronary heart disease mortality in Finland, but not in the Netherlands and Italy. In Italy we noted an interaction among HDL cholesterol, body mass index, and alcohol intake, with an inverse association for HDL cholesterol in lean men who drank <40 gm of alcohol daily and a positive association for HDL cholesterol among overweight men who drank > or =40 gm of alcohol per day. Serum total cholesterol remains an important predictor of coronary heart disease mortality in elderly men in different European countries. The effect of HDL cholesterol differed among the three countries.     

Coronary heart disease mortality in the Western Collaborative Group Study. Follow-up experience of 22 years

In 1960-1961, 3,154 healthy, middle-aged men were entered into the Western Collaborative Group Study, a long-term study of coronary heart disease. A 22-year mortality follow-up of this cohort in 1982-1983 accounted for almost 99% of the cohort, and determined that 214 of the men had died of coronary heart disease. The risk of coronary heart disease mortality was studied for several variables measured at baseline, i.e., Type A/B behavior, systolic blood pressure, serum cholesterol level, cigarette smoking status, and age. Using a proportional hazards regression model, systolic blood pressure, serum cholesterol level, cigarette smoking status, and age were highly significant predictors (p less than 0.001) of 22-year coronary heart disease mortality. Type A/B behavior showed no association with 22-year coronary heart disease mortality (standardized relative hazard (SRH) = 0.98, 95% confidence interval (CI) = 0.85-1.12). Systolic blood pressure, serum cholesterol, and age showed relatively consistent positive associations with coronary heart disease mortality over four successive time intervals after the baseline examination. Cigarette smoking showed a significant positive association in the first and second intervals and a nonsignificant positive association in the third and fourth intervals. Type A/B behavior was positively but not significantly associated with coronary heart disease in the first and third intervals, significantly negatively associated (SRH = 0.70, 95% CI = 0.53-0.93) in the second interval and not associated in the fourth interval. The results confirm the importance of the traditional coronary heart disease risk factors, and raise a substantial question about the importance of Type A/B behavior as a risk factor for coronary heart disease mortality.     

Serum cholesterol and 20-year mortality in black and white men and women aged 65 and older in the Evans County Heart Study.

Serum cholesterol and 20-year mortality rates were studied in 396 Evans County black and white men and women who were 65 years and older and free of prevalent coronary heart disease (CHD) at baseline examination in 1960 to 1962. Previous reports on Evans County men and women younger than 65 found cholesterol levels to be significantly associated with all-cause and CHD mortality in white men, with CHD mortality in black men, and with cardiovascular disease mortality in white women. The independent role of total serum cholesterol as a predictor of CHD and all-cause mortality in the 65-and-older age group was evaluated using Cox proportional hazards models. Among white men, serum cholesterol level was positively associated with CHD mortality (relative risk of 1.54, P < 0.05 for an increment of 40 mg/dL [1.03 mmol/L], or one standard deviation in cholesterol). A significant J-shaped relationship of cholesterol with all-cause mortality was found among white men. Among black women, cholesterol was negatively associated with all-cause mortality. Neither all-cause nor CHD mortality was related to serum cholesterol among black men or white women. Although based on small numbers, the results of this study suggest that in Evans County, total serum cholesterol is an independent predictor of mortality in white men aged 65 and over, while these results should not be generalized to other race-gender groups in this cohort.     

Serum triglycerides and risk of coronary heart disease among Japanese men and women

To examine the relation of triglycerides with coronary heart disease among populations with low mean total cholesterol, the authors conducted a 15.5-year prospective study ending in 1997 of 11,068 Japanese aged 40-69 years (4,452 men and 6,616 women with mean total cholesterol = 4.73 mmol/liter and 5.03 mmol/liter, respectively), initially free of coronary heart disease or stroke. There were 236 coronary heart disease events comprising 133 myocardial infarctions, 68 angina pectoris events, and 44 sudden cardiac deaths. The coronary heart disease incidence was greater in a dose-response manner across increasing quartiles of nonfasting triglycerides for both sexes. The multivariate relative risk of coronary heart disease adjusting for coronary risk factors and time since last meal associated with a 1-mmol/liter increase in triglycerides was 1.29 (95% confidence interval (CI): 1.09, 1.53; p = 0.004) for men and 1.42 (95% CI: 1.15, 1.75; p = 0.001) for women. The trend was similar for myocardial infarction, angina pectoris, and sudden cardiac death. The relation of triglycerides with coronary heart disease was not influenced materially by total cholesterol levels or, in a subsample analysis (51% of total sample), by high density lipoprotein cholesterol levels. Nonfasting serum triglycerides predict the incidence of coronary heart disease among Japanese men and women who possess low mean values of total cholesterol. Further adjustment for high density lipoprotein cholesterol suggests an independent role of triglycerides on the coronary heart disease risk.     

Short and long term association of a single serum cholesterol measurement in middle-aged men in prediction of fatal coronary and other cardiovascular events: A cross-cultural comparison through Europe

Aims: The purpose was to study the association of a single serum cholesterol measurement with early and late coronary and other cardiovascular deaths during 35 years of follow-up in samples of men aged 40–59 years in five European countries. Methods and results: A single serum total cholesterol measurement was considered in samples from Finland (N = 1563), the Netherlands (N = 811), Italy (N = 1642), Serbia (N = 1537) and Greece (N = 1158) (total = 6711). Seven partitioned proportional hazards models were solved, one for each of seven independent 5-year blocks, to predict coronary, stroke, cardiovascular disease and all-cause mortality risk. Partitioned hazard scores were cumulated. The resulting curves showed a relatively constant strength in risk for coronary deaths as a function of baseline serum cholesterol levels, although a strong relationship during the first 10-year period was followed by a weaker relationship later on. The pooled estimates for the five countries gave a relative risk for 1 mmol/l of serum cholesterol (95% confidence intervals) of 1.44 (1.23–1.68) for the first period; 1.52 (1.31–1.76) for the second period; and 1.16 (1.02–1.32) for the third period; 1.18 (1.05–1.32) for the forth period; 1.17 (1.05–1.31) for the fifth period; 1.22 (1.10–1.35) for the sixth period; 1.18 (1.05–1.32) for the seventh 5-year period of follow-up. No significant relationship were found between serum cholesterol and stroke and all-cause mortality, while intermediate findings were obtained for cardiovascular diseases. Conclusion: A single serum cholesterol measurement in middle aged-men maintains a strong relationship with the occurrence of coronary heart disease (CHD) deaths during 35 years of follow-up.     

Socioeconomic indicators and mortality from coronary heart disease and cancer: a 22-year follow-up of middle-aged men.

OBJECTIVES: Data from the Western Collaborative Group Study were used to determine the extent to which the inverse association between socioeconomic status (SES) and mortality can be explained by risk factors for major causes of mortality. METHODS: The relation of education and income to subsequent mortality was studied in 3154 employed, middle-aged men over 22 years of follow-up. RESULTS: Over the follow-up period, 584 (18.5%) men died, 214 (6.8%) from coronary heart disease and 70 (2.2%) from lung cancer. A significant inverse association with systolic blood pressure, serum cholesterol, and smoking was found only for education. For education, adjustment for risk factors reduced the relative risk for coronary heart disease mortality from 1.80 (95% confidence interval = 1.33, 2.44) to 1.54 (1.13, 2.09), for lung cancer mortality from 1.60 (0.95, 2.70) to 1.38 (0.81, 2.34), and for all-cause mortality from 1.49 (1.09, 1.13) to 1.33 (1.12, 1.60). For income, adjustment for risk factors did not change relative risk for mortality from coronary heart disease (1.27 [0.97, 1.66]) and all causes (1.21 [1.03, 1.43]), but it did increase the relative risk for lung cancer mortality from 1.68 (1.05, 2.68) to 1.83 (1.13, 2.96). CONCLUSIONS: In middle-aged, employed men, the association between SES and mortality is partially but not completely accounted for by major risk factors for mortality.     

Forty-Year Mortality From Cardiovascular Diseases and All Causes of Death in the US Railroad Cohort of the Seven Countries Study

Forty-year mortality and its association with entry risk factor levels is reported in men employed in the US Railroad industry within the Seven Countries Study of Cardiovascular Diseases. Cardiovascular risk factors were measured in 2571 men aged 40-59 at entry examination in 1957-1959 and after 5 years. Mortality data were collected during 40 years of follow-up (overall mortality of 83.4%). The main causes of death were coronary heart disease (CHD, 32.9% of all causes using strict criteria), atherosclerotic cardiovascular diseases (including coronary, stroke and peripheral artery diseases, (ACVD), 53.2% of all causes) and cancer (25.1% of all causes). Multivariate analysis showed that age, systolic blood pressure, serum cholesterol and cigarette consumption were strongly and significantly associated with all-cause mortality, coronary mortality and cardiovascular mortality. Multivariate relative risks per 5 years of age were 1.31 for all-causes, 1.32 for CHD and 1.36 for ACVD; per 20 mmHg systolic blood pressure were 1.12, 1.23 and 1.26, respectively; per 1 mmol/l of serum cholesterol were 1.06, 1.18 and 1.14, respectively; and per 10 cigarettes smoked per day were 1.14, 1.12 and 1.13, respectively. During a 40-year period classical cardiovascular risk factors were highly predictive of coronary, cardiovascular and all-cause mortality in a US working population.     

Smoking,blood pressure and serum cholesterol-effects on 20-year mortality

BACKGROUND: To study the impact of smoking and blood pressure conditional on serum total cholesterol levels, we investigated the 20-year mortality risk associated with high systolic blood pressure (> or =140 mmHg) and smoking, at low (<5.2 mmol/Liter), medium (5.2-6.49mmol/Liter), and high (> or =6.5 mmol/Liter) serum total cholesterol levels. METHODS: The study population comprised a cohort of 50,000 men and women age 30-54 years, examined between 1974 and 1980, in five Dutch towns. The duration of follow-up averaged 20 years. Age-adjusted relative risks (RRs) for mortality from coronary heart disease (CHD), cardiovascular diseases (CVD) and all causes were estimated, for six risk profiles (based on levels of total cholesterol, systolic blood pressure and smoking), using Cox proportional hazards analysis. RESULTS: Given a low cholesterol level, smoking had a larger impact than elevated blood pressure on CHD, CVD and all-cause mortality. The combination of elevated blood pressure and smoking among persons with low cholesterol was associated with RRs of 3.0 for CHD, 6.0 for CVD and 4.1 for all-cause mortality in men, and 2.3, 3.6 and 2.6, respectively, in women. Among persons with high cholesterol, the combination of high blood pressure and smoking was associated with RRs of 9.7 for CHD, 13.9 for CVD and 5.7 for all-cause mortality in men, and 15.9, 9.3 and 4.3, respectively, in women. For each risk profile, the absolute number of CHD, CVD and total deaths was larger in men than in women. CONCLUSIONS: The results demonstrate the potential power of a multifactorial approach to risk factor reduction in the prevention of cardiovascular diseases and all-cause mortality.     

Risk factors and 28 year morbidity and mortality of coronary heart disease in a cohort with a low incidence of the disease: the Manresa Study

BACKGROUND: To Study the incidence of coronary heart disease (CHD) and all-cause mortality in a cohort of men followed during 28 years, and their association with serum cholesterol, systolic blood pressure, glycemia, cigarette smoking and body mass index measured at baseline. METHODS: A cohort of 1,059 men aged 30 to 59 years and free of cardiovascular diseases at baseline in 1968, was reexamined every five years until 1988. The last examination was performed in 1996. Information was collected on 96.4% of the participants. RESULTS: Incidence and mortality rates from CHD and from all-causes of death per 10(5) person-years of observation were 499.80, 235.80 y 925.33, respectively. At the end of follow-up, high levels of serum cholesterol and smoking were independently associated with the incidence and mortality from CHD controlling by age, blood pressure, glycemia and BMI. Serum cholesterol, hyperglycemia and smoking were independently associated with all-cause mortality. CONCLUSIONS: In this industrial cohort of men, with relative low incidence of CHD, smoking and serum cholesterol at baseline remained associated with the incidence of CHD through 28 years of observation.     

Serum selenium and the risk of coronary heart disease and stroke

The association between serum selenium concentration and five-year risk of cardiovascular disease was studied in 1,110 men aged 55 to 74 years in two rural areas of Finland. In the total cohort, all-cause and cardiovascular deaths were associated significantly with serum selenium of less than 45 micrograms/liter, an adjusted relative risk of 1.4 (95% confidence interval (Cl), 1.0-2.0, p less than 0.05) and 1.6 (95% Cl, 1.1-2.3, p less than 0.05), respectively. Among men free of coronary heart disease at the outset, these associations were of similar magnitude but did not attain statistical significance. Among men free of stroke at the outset, low serum selenium was associated significantly with stroke mortality, an adjusted relative risk of 3.7 (95% Cl, 1.0-13.1). The associations of coronary deaths and myocardial infarctions with low serum selenium were nonsignificant.     

Trend in serum total cholesterol level in 110,000 young adults in The Netherlands, 1974 to 1986.

Data from two screening projects on cardiovascular risk factors were used to analyze the trend in serum total cholesterol level in the Netherlands between 1974 and 1986. Cholesterol levels were measured in a single reference laboratory of the World Health Organization throughout the entire study period. Between 1974 and 1980, about 30,000 men and women aged 37 to 43 years (mean age, approximately 40 years) were screened. A decrease in mean serum total cholesterol level was observed until the end of 1977, when it was followed by an increase. This resulted in a net change over the entire study period of -0.07 mmol/liter (3 mg/dl) in men and -0.03 mmol/liter (1 mg/dl) in women. Between 1981 and 1986, about 80,000 men aged 33 to 37 years (mean age, 35 years) were screened. During this period, a decrease of 0.20 mmol/liter (8 mg/dl) in the mean total cholesterol level was observed. In spite of the decline in the mean total cholesterol level, the prevalence of cholesterol values of greater than or equal to 6.5 mmol/liter (greater than or equal to 251 mg/dl) in young adult men was still high in 1986 (16 percent). A further reduction is therefore desirable. The decline in the mean total cholesterol level in young adults might indicate that a further decline in mortality from coronary heart disease can be expected.     

Relation of cigarette smoking to 25-year mortality in middle-aged men with low baseline serum cholesterol: the Chicago Heart Association Detection Project in Industry

It has been suggested that smoking does not influence risk of cardiovascular diseases in populations with low serum cholesterol levels. To determine whether cigarette smoking is an independent risk factor among men with low levels of serum cholesterol, data on 25-year coronary, cardiovascular, and all-cause mortality for 8,816 middle-aged men screened between 1967 and 1973 by the Chicago Heart Association Detection Project in Industry were examined. With Cox multivariate proportional hazards regression, relative risks of coronary heart disease and cardiovascular disease mortality associated with smoking for the two subcohorts with favorable levels of serum total cholesterol, that is, less than 180 and 180-199 mg/dl, were of the same magnitude as those for men with elevated serum cholesterol, that is, 200-239 and 240 mg/dl. In the two lower strata of cholesterol, the absolute risk and absolute excess risk of mortality for current smokers at baseline were substantially higher compared with men who never smoked, with all-cause death rates of 423.0 and 428.0 per 1,000 and absolute excess rates of 209.8 and 225.7 per 1,000. These translate to estimated shorter life expectancies of 5.3 and 5.7 years, respectively. Adverse effects of smoking on risk of coronary, cardiovascular, and all-cause mortality prevail for men with lower as well as higher serum cholesterol levels.     

Change of serum albumin and risk of cardiovascular disease and all-cause mortality: Longitudinal Aging Study Amsterdam

The aim of this longitudinal study was to investigate 3-year change in serum albumin concentration as a determinant of incident cardiovascular disease (CVD) and all-cause mortality. Data were from 713 respondents of the Longitudinal Aging Study Amsterdam initially aged 55-85 years. Serum albumin was measured at baseline (1992/1993) and after 3 years. At the 6-year follow-up, incident CVD (among 456 respondents with no prevalent CVD at the 3-year follow-up) and all-cause mortality were ascertained. Overall, 18.9% developed CVD and 10.9% died. After adjustment for potential confounders, a higher level of serum albumin at the 3-year follow-up was associated with a lower risk for incident CVD (relative risk = 0.88, 95% confidence interval (CI): 0.79, 0.98). The risk of incident CVD was 0.88 (95% CI: 0.78, 0.99) per unit (g/liter) increase in change in albumin between 3-year follow-up and baseline. Chronic low serum albumin (or=1 standard deviation (2.5 g/liter) between baseline and 3-year follow-up) tended to be associated with a twofold risk (relative risk = 2.00, 95% CI: 0.91, 4.39). For all-cause mortality, no associations were observed. These findings suggest that older persons with a decrease in serum albumin concentration, even within the normal range, might be at increased risk of incident CVD. Change in serum albumin may be used as an early marker for CVD risk.     

Leukocyte count and risk of major coronary heart disease events.

The association between leukocyte count and subsequent risk of major coronary heart disease events was examined using data from three prospective cohort studies--two from the United States and one from Great Britain. A total of 28,181 middle-aged men were followed for 6-12 years. A total of 1,768 men had a nonfatal myocardial infarction or died of coronary heart disease. In all three cohorts, there was a positive, statistically significant relation between baseline leukocyte count and risk of subsequent major coronary heart disease events after adjustment for age, serum total cholesterol, diastolic blood pressure, and number of cigarettes smoked per day (relative odds = 1.32 (p less than 0.0001), 1.15 (p = 0.0001), and 1.14 (p = 0.003), corresponding to a 2,000/mm3 difference in leukocyte count). The associations persisted when all nonsmokers (former smokers plus never smokers) and never smokers alone were considered and when those with evidence of preexisting coronary heart disease at baseline were excluded. Leukocyte count appears to be an indicator of a person's future risk of major coronary heart disease events.     

High density lipoprotein cholesterol and the risk of stroke in elderly men: the Honolulu heart program

High density lipoprotein (HDL) cholesterol has been inversely associated with coronary heart disease. Associations with stroke are less clear, particularly among the elderly. In this study, the authors examined the relation between HDL cholesterol levels and the risk of stroke in elderly men. Levels of HDL cholesterol were measured in 2,444 Honolulu Heart Program men aged 71-93 years at the 1991-1993 examinations. The participants, who were free of prevalent stroke, coronary heart disease, and cancer at baseline, were followed to the end of 1998 for thromboembolic and hemorrhagic stroke. While HDL cholesterol was unrelated to hemorrhagic events, incidence of thromboembolic stroke declined consistently with increasing HDL cholesterol level (p = 0.003). There was a nearly threefold excess of thromboembolic stroke in men with low HDL cholesterol levels (<1.0 mmol/liter (<40 mg/dl)) compared with men with high levels (> or =1.6 mmol/liter (> or =60 mg/dl)) (10.6/1,000 person-years vs. 3.6/1,000 person-years; p = 0.001). Adjustment for other risk factors had little effect on these findings, although associations appeared strongest in elderly men with "desirable" total cholesterol levels, hypertension, or diabetes mellitus. These findings suggest that HDL cholesterol level is inversely related to the risk of thromboembolic stroke in elderly men. Whether HDL cholesterol alters the effect of other factors on stroke risk in elderly men warrants further study.     

The predictive role of blood glucose for mortality in subjects with cardiovascular disease

Using the Framingham Heart Study data (United States, 1948-1978), the authors examined the association of blood glucose with 2-year all-cause, cardiovascular, and noncardiovascular mortality in subjects with documented cardiovascular disease. After adjustment for systolic blood pressure, cholesterol, body mass index, cigarette smoking, and use of antihypertensive agents, they found that glucose was a strong, independent predictor of mortality. However, the relations for men and women were qualitatively different. For men, adjusted mortality risk increased very rapidly through the normal range (from 4.12% at 3.89 mmol/liter (70 mg/dl) to 12.26% at 5.55 mmol/liter (100 mg/dl)) and was flat at 12.26% thereafter. For women, risk was flat at 3.65% through the normal range and then increased rapidly, reaching 8.34% at 6.99 mmol/liter (126 mg/d), but increased much more slowly thereafter. Exactly analogous relations held for cardiovascular mortality. For men and women combined, noncardiovascular mortality increased from 1.82% at 3.89 mmol/liter to 2.06% at 5.55 mmol/liter to 2.29% at 6.99 mmol/liter (p for trend = 0.009). These findings suggest that although 5.55 mmol/liter (normal) may be a useful mortality risk division (albeit with different implications for the two sexes), 6.99 mmol/liter (diabetic) is not, especially for men.     

Postmenopausal estrogen use and mortality. Results from a prospective study in a defined, homogeneous community

The authors studied the association between postmenopausal estrogen use and mortality from cardiovascular disease, coronary heart disease, cancer, and all causes in a cohort of 1,868 women aged 50-79 years residing in a planned community. After 12 years, the age-adjusted all-cause mortality rate was lower in the 734 postmenopausal estrogen users (14.9/100 women) compared with the 1,134 nonusers (21.5/100 women) (relative risk (RR) = 0.69, 95% confidence interval (Cl) 0.55-0.87). After adjustment for age, systolic blood pressure, social class, fasting plasma cholesterol, fasting plasma glucose, Quetelet index (weight (lbs)/height (in)2 x 100), and cigarette smoking by the Cox model, the relative risk increased to 0.79 (95% Cl 0.62-1.01). Because a postmenopausal estrogen-smoking interaction term was significant (p = 0.025), separate Cox models were run for never, past, and current smokers. In never and current smokers, estrogen was protective for all-cause mortality, with relative risks of 0.67 (95% Cl 0.45-0.99) and 0.62 (95% Cl 0.39-0.98), respectively. However, past smokers were not protected by postmenopausal estrogen use (RR = 1.32, 95% Cl 0.84-2.08). Cause-specific models revealed differences in the association of postmenopausal estrogen use with cardiovascular disease mortality and coronary heart disease mortality that were dependent on smoking status. Postmenopausal estrogen use was strongly protective in current smokers but was associated with increased risk in past smokers. As expected, cancer mortality was increased in smokers. The confidence intervals for the relative risk estimate of postmenopausal estrogen use for cancer mortality in each smoking category included one. Finally, a separate analysis of subsequent three-year mortality in women surviving the first nine years of follow-up revealed reduced death rates only for women using estrogen at both baseline and nine years of follow-up, suggesting both a conservative bias in our data introduced by the large reduction in postmenopausal estrogen use during the study period and the possibility of a stronger protective effect for recent postmenopausal estrogen use.     

Risk factors for coronary heart disease and level of education. The Troms? Heart Study

The relation between level of education, lifestyle variables, and major risk factors for coronary heart disease were analyzed in 12,368 men and women in Troms?, Norway. Subjects with the highest education tended to be less overweight, smoke less, be more physically active in leisure time, and have food habits assumed to be less atherogenic (i.e., drink less coffee, use soft margarine and low-fat milk, and eat fruits and vegetables daily) than persons with low education. In men and women, mean serum total cholesterol and systolic blood pressure were negatively associated with educational level, while high density lipoprotein (HDL) cholesterol was positively associated with this variable in women only. The differences between the extreme groups of education (less than 8 and greater than 16 years of education) were as follows: 0.52 mmol/liter (20 mg/100 ml) for serum total cholesterol; 0.03 and 0.14 mmol/liter (1 and 5 mg/100 ml) in men and women, respectively, for HDL cholesterol; and 1.9 and 5.6 mmHg in men and women, respectively, for systolic blood pressure. Adjustment of the relations between level of education and serum total cholesterol and systolic blood pressure for several variables (including food habits) reduced the strength of the associations, which, however, were still statistically significant. For HDL cholesterol, a negative association was found in men when adjustments were done, and the positive association originally observed in women disappeared.     

Total and HDL cholesterol and their correlates in elderly men in Finland, Italy, and The Netherlands

In 1984 and 1985, 25-year follow-up studies were carried out in the Italian, Finnish, and Dutch cohorts of men originally examined around 1960 in the Seven Countries Study. Risk factors for coronary heart disease were determined in 2,255 men aged 65-84 years. The average serum total cholesterol levels of the elderly men in Finland and the Netherlands were similar, at around 236 mg/dl (6.10 mmol/liter). The average serum total cholesterol levels of the elderly men in Italy were about 10 mg/dl (0.26 mmol/liter) lower. During 25 years of follow-up, the average serum total cholesterol level increased by 29 mg/dl (0.75 mmol/liter) among the Italian survivors, decreased by 23 mg/dl (0.59 mmol/liter) in the Finnish survivors, and did not change in the Dutch survivors. Age, Quetelet index, and coffee consumption were the most important correlates of total cholesterol in these elderly men. Quetelet index, alcohol consumption, age, and cigarette smoking were significantly associated with high density lipoprotein (HDL) cholesterol. The results of this study suggest that modifiable risk factors are related to total and HDL cholesterol in elderly men in different cultures.