From a Few Cardiovascular Risk Factors to the Prediction of Age at Death: The Shifting Interests of Cardiovascular Epidemiologists.

We describe the changing research interests and goals of the responsible investigators of the Italian Rural Areas (IRA) of the Seven Countries Study of cardiovascular diseases (CVD) during a period of 60 years, dealing with a cohort of middle-aged men. Our initial interest was to discover the basic risk factors of coronary heart disease (CHD). Subsequently, the same problem was tackled regarding stroke and heart diseases of uncertain etiology. Later on, cancer deaths also became an end-point for which risk factors were investigated. The long duration of the study and the fact that CVD and cancer fatalities already cover 70% of all-cause mortality prompted the idea to focus on all-cause mortality, and particularly on age-at-death when the follow-up period reached 61 years together with the extinction of the cohort. At that point, a larger number of risk factors measured at baseline, including those which were unable to predict CVD, became the determinants of all-cause mortality and age-at-death, a metric that summarizes the life-span of health and disease. This study is supported by the presentation of data derived from published papers.