Mediterranean diet score: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study.
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Biomedical subjects
M Lanti
Publications and source records attributed to M Lanti.
Mediterranean Adequacy Index: correlation with 25-year mortality from coronary heart disease in the Seven Countries Study.
BACKGROUND AND AIM: The Mediterranean Adequacy Index (MAI) is an overall indicator characterising a diet in comparison with a Reference Mediterranean Diet. We computed the MAI of random samples of men surveyed for their eating habits in the 16 cohorts of the Seven Countries Study, and found that it inversely correlated with the 25-year death rates from coronary heart disease in the 16 cohorts (R = -0.72; p = 0.001). The correlation coefficient was -0.84 (p < 0.001) when the MAI was converted into natural logarithms. CONCLUSIONS: These findings once again support the association between typical Mediterranean eating habits and protection against coronary heart disease.
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Twenty-five-year coronary mortality trends in the seven countries study using the accelerated failure time model.
The 'accelerated failure time model' (AFT) was tested in the 25-year experience of the Seven Countries Study, to describe the shape of hazard for coronary heart disease (CHD) mortality during long-term follow-up. Sixteen cohorts of men aged 40-59 at entry were enrolled in eight countries (USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan) for a total of 12,763 subjects. Risk factors were measured and CHD mortality data collected during 25 years. The AFT incorporating the Weibull survival distribution was applied to the pooled cohorts of each country, with CHD mortality as endpoint. Cumulative hazards and the annual hazard for CHD mortality were estimated during 25 years and compared among countries. The annual hazard for CHD in 25 years tended to reduce relatively or flatten out in the northern American and northern European countries, exponentially increased in Serbia and Japan, and increased moderately in the other countries of southern Europe. Positive correlations were found between the shape of the hazard curve and population mean risk factor changes (serum cholesterol and systolic blood pressure) observed during the first 10 years follow-up. The Japanese group was an outlier. The countries with the largest relative decline in the annual hazard function were the same where, during the same historical period, the largest decreases in official death rates from CHD were recorded and vice versa. The curve shape in the annual hazard for CHD mortality in different countries seems related to changes in mean levels of serum cholesterol and systolic blood pressure.
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Coronary risk factors predicting early and late coronary deaths.
OBJECTIVE: To study the time related association of a single measurement of coronary risk factors with coronary heart disease (CHD) deaths occurring during a very long follow up period in a population sample of middle aged men. DESIGN, SETTING, AND METHODS: Age, systolic blood pressure, serum total cholesterol, physical activity at work, body mass index, and cigarette smoking were measured once in 1622 CHD-free men aged 40-59 belonging to the Italian rural cohorts of the seven countries study. During 35 years of follow up 214 men died from CHD (sudden death and definite myocardial infarction). Seven partitioned proportional hazards models were solved, one for each independent five year block of follow up, to predict the risk of CHD death. RESULTS: The seven, five year partitioned hazard functions were cumulated and smoothed for each risk factor. The resulting curves showed a regularly increasing time trend in risk for coronary deaths as a function of age, serum cholesterol, systolic blood pressure, and cigarette smoking and a regularly decreasing risk for physical activity. The curves fit straight lines, with large squared correlation coefficients ranging from 0.92-0.97. This suggests a relatively constant strength in the association of risk factor levels with events, which are predicted whatever the length of time after risk factors were measured. These findings were not altered by adding to the models risk factor changes preceding the quinquennium of death. CONCLUSION: A single measurement of some coronary risk factors in middle aged men maintains a regular and almost monotonic relation with the occurrence of CHD deaths during 35 years of follow up.
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Cardiovascular risk factors as determinants of 25-year all-cause mortality in the seven countries study.
This analysis aims at describing all-cause mortality and their determinants in 16 cohorts of middle-aged men of eight nations. A total of 12,763 men aged 40-59 years were enrolled in the late 1950s and early 1960s in 16 cohorts located in the USA, Finland, The Netherlands, Italy, Croatia, Serbia, Greece and Japan. The highest death rates were found in Slavonia-Croatia, due to high rates of infectious diseases and violence (death rate of 610 per 1000), and in East Finland due to high rates from coronary heart disease (death rate of 597 per 1000). The lowest death rates were found in a highly educated group in Belgrade, Serbia (death rate 295 per 1000) and in Crete, Greece (death rate 314 per 1000). The ecological analysis showed no significant relationship between mean risk factor levels and all-cause death rates except for the direct association with systolic blood pressure during the first 15 years follow-up. Individual multivariate analysis on eight national pools showed that age, systolic blood pressure, and smoking habits are direct, significant, and universal long-term predictors of all-cause mortality. Serum cholesterol, physical activity and body mass index were so only in some areas. Multivariate coefficients were similar across nations. Pooled hazards ratios were 1.55 for a difference of 5 years of age (CI: 1.51-1.59); 1.23 for 10 cigarettes smoked per day (CI: 1.20-1.26); 0.91 for one unit (based on three grades) of physical activity score (CI: 0.87-0.95); 1.04 for 1 mmol/l of serum cholesterol (CI: 1.02-1.07); and 0.93 for three units of body mass index (CI: 0.91-0.96). In conclusion some cardiovascular risk factors predict long-term risk of all-cause mortality in different cultures.
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Impact of the Gubbio population study on community control of blood pressure and hypertension. Gubbio Study Research Group.
BACKGROUND: Awareness and treatment of hypertension have markedly increased in the last 30 years in most parts of the world, but a satisfactory control of blood pressure is still infrequent OBJECTIVES: To describe trends in community control of hypertension and blood pressure levels in the small town of Gubbio, Italy. METHODS: Large samples of the populations (aged 30-79 years) were examined 6 years apart for measurement of blood pressure, other cardiovascular risk factors and knowledge, attitude and practice towards control of hypertension. Data were available from a total of 1125 men and 1445 women with two examinations and 1566 men and 1658 women with at least one examination. Two different definitions of hypertension were used (old definition: systolic blood pressure (SBP) > or = 160 mmHg or diastolic blood pressure (DBP) > or = 95 mmHg or use of antihypertensive drugs; recent definition: SBP > or = 140 mmHg or DBP > or =90 mmHg or use of anti-hypertensive drugs). RESULTS: Awareness, treatment and control of hypertension increased from one survey to the other, whatever definition of hypertension was used. Control rose from 41 to 63% (old definition) and from 12 to 24% (recent definition). In a 6-year period, the average population SBP declined 2-8 mmHg and DBP declined 2-3 mmHg depending on type of analysis, against an expected rise of 9 mmHg for SBP and 2 mmHg for DBP. These trends are partly explained by a marked decline in alcohol consumption and by more common and intensive anti-hypertensive treatment, while change in body mass index, which showed a slight but systematic increase, cannot be considered as a contributor to this trend. CONCLUSIONS: An epidemiological study has motivated a population group and its medical profession towards a better control of hypertension.
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The duration of the association between serum cholesterol and coronary mortality: a 35-year experience.
OBJECTIVE: Our purpose was to study the time-related association between a single measurement of total serum cholesterol and the occurrence of coronary deaths in a population sample of middle-aged men. DESIGN: This is a longitudinal population study with multiple measurements of serum cholesterol and a 35-year follow-up for coronary mortality in 1622 coronary disease-free men aged 40-59 years belonging to the Italian rural cohorts of the Seven Countries Study. METHOD: A single measurement of serum cholesterol (plus those of five other risk factors as possible confounders) was considered. During 35 years of follow-up, 214 men died from coronary heart disease. Annual partitioned proportional hazards models were solved, one for each independent year of follow-up, to predict the risk of coronary heart disease deaths. Single-year hazard functions were cumulated and smoothed. Similar analyses were made starting from cholesterol measurements taken at years 5, 10 and 20 of follow-up. RESULTS: The resulting hazard curves showed regularly increasing risk for coronary events and fitted straight lines with large correlation coefficients, demonstrating a strong association of serum cholesterol with both early and late events. The slopes were steeper for cholesterol measurements taken at younger ages. The slope for cholesterol measurement taken at year 20 (age 60-84 years) was flat. In slopes starting at an early age, two components could be isolated corresponding to different associations with events (stronger for early events when measurements were taken around the age of 50 years and for late events when measurements were taken around the age of 55 or 60 years). CONCLUSION: A single measurement of total serum cholesterol in middle-aged men maintains a relatively monotone relationship with the occurrence of coronary heart disease deaths over 35 years. In the study population, measurements taken in late adulthood had smaller or null association with coronary disease deaths.
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Serum uric acid for short-term prediction of cardiovascular disease incidence in the Gubbio population Study.
OBJECTIVE: The Gubbio Study is an Italian population study measuring risk factors for and incidence of major cardiovascular diseases. This analysis investigates the association of serum uric acid with the incidence of coronary and cardiovascular events. METHODS: A population sample of 2469 men and women aged 35-74 years, free from major cardiovascular diseases and in whom serum uric acid was measured in 1983 along with other standard risk factors, were followed up for 6 years and the incidence of coronary heart disease (CHD) and all cardiovascular atherosclerotic (CVD) events, both fatal and non-fatal, was computed. Proportional hazards models were used for the prediction of these events. RESULTS: In six years 61 CHD hard criteria, 109 CHD any criterion and 149 CVD events were recorded. Age-adjusted rates per 1000 of the 3 event categories were computed in sex-specific quintiles (Q) of serum uric acid with 428 +/- 76 (Q5) and 198 +/- 42 (Q1) micromol/l, respectively. Although higher rates were seen in Q5 as compared to Q1 for all three first event categories considered (relative risks 6.2, 3.6 and 3.7, respectively), a statistically significant trend was seen only for CVD all criteria (t = 3.63, p < 0.036). These trends were borderline significant for CHD any criterion (t = 2.92, p < 0.06) and not significant for CHD hard criteria (t = 2.23, p < 0.11). In multivariate models, adjusted for 8 other risk factors, serum uric acid showed a statistically significant contribution to predict CVD incidence [relative risk (RR) for 92 micromol/l difference of 1.24 with 95% confidence intervals (CI) 1.05-1.45], whereas the statistical contribution to predict CHD any criterion (RR = 1.19 with CI 0.98-1.45) and CHD hard criteria (RR = 1.20 with CI 0.93-1.55) was not significant. Diuretic treatment and blood urea, as further confounders, were positively and significantly related to event incidence (RR ranging from 1.21 to 2.00) but serum uric acid maintained its independent and statistically significant role in the prediction of CVD events (RR = 1.18 with CI 1.00-1.39). Presence of specific treatments to lower serum uric acid levels (in 1.13% of the population), tested as final confounders, was not statistically contributory. CONCLUSIONS: Increased serum uric acid levels are independently and significantly associated with risk of CVD events in the 6-year follow-up of the Gubbio Study. Longer follow-up is needed before the contributory role of serum uric acid can be properly assessed to explain CHD incidence.
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Comparison of the Framingham risk function-based coronary chart with risk function from an Italian population study.
AIMS: The aim is to compare the coronary risk chart published by the European Task Force for Prevention of Coronary Heart Disease and produced using a Framingham risk function, with a risk function derived from an Italian population study. METHODS AND RESULTS: Coronary risk function in this study was the result of longitudinal experience in an Italian middle-aged population of 1656 male subjects followed-up for 25 years. To comply with the Framingham equation the same risk factors (age, systolic blood pressure, total serum cholesterol and smoking habits), end-points (any possible coronary event including angina pectoris), and length of follow-up (10 years) were used, and the model (log-linear accelerated time failure model, accommodating the Weibull distribution) was similar. Comparisons were made computing the coronary risk for each cell of the coronary risk chart for men aged 40, 50 and 60 years. The Italian risk function produced highly significant coefficients for all four risk factors. Forty-four out of a total of 120 cells had a coronary risk of 20% or more in 10 years following the coronary risk chart, whereas this was reduced to four while using the Italian risk function (P<0.001). The Italian risk function largely underestimated the corresponding levels produced by the coronary risk chart and vice versa. CONCLUSION: The Framingham risk function-based coronary risk chart overestimates absolute coronary risk in countries characterized by a lower incidence of coronary events and should be used with caution.
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Coronary heart disease incidence in northern and southern European populations: a reanalysis of the seven countries study for a European coronary risk chart.
OBJECTIVE: A systematic reanalysis of 10 year coronary heart disease incidence data from the northern and the southern European cohorts of the seven countries study, to contribute indirectly to the production of a European coronary risk chart. DESIGN AND SETTING: Men aged 40-59 years at entry were studied in three northern European cohorts based in Finland and Netherlands (n = 2213); and in 10 southern European cohorts based in Italy, former Yugoslavia, and Greece (n = 5897). Multiple logistic models for the prediction of coronary deaths, coronary incidence (hard criteria), and coronary incidence (any criterion) were solved for the two geographical groups and their pool. Risk factors fed into the models were age, systolic blood pressure, serum total cholesterol, and cigarette smoking. RESULTS: 10 year coronary heart disease mortality and incidence were higher in northern than in southern Europe, with ratios around 2.65. Ratios among the three coronary heart disease manifestations were identical in the two cultural groupings. Coefficients of the multiple logistic models were similar and not significantly different between the two groupings. When applying the coefficients back to the same or the opposite population, the relative risk was large and similar in the different cultures. Relative risk was larger for more severe coronary heart disease manifestations. The absolute risk was overestimated when applying the northern European model to southern European populations and vice versa, with ratios of about 1.5 and 0.5, respectively. Coronary risk charts created to reproduce the shape of those incorporated in recent European guidelines confirmed the excess of absolute risk in the northern compared with the southern European cohorts, all else being equal. CONCLUSIONS: In theory, a more appropriate European coronary risk chart could be produced by adopting coefficients to correct for different background incidence rates in different cultures. Other coefficients could appropriately be used to transform mortality risk into incidence risk.
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Long-term time-related predictivity of coronary events as a function of a single measurement of serum cholesterol and systolic blood pressure.
OBJECTIVE: To study the time-related association of a single measurement of serum cholesterol and systolic blood pressure with the occurrence of a first coronary event in a population sample of middle-aged men. METHODS AND RESULTS: A single measurement of serum total cholesterol and systolic blood pressure (along with age, cigarette consumption, physical activity at work and body mass index as possible confounders) was made in 1,605 coronary disease-free men aged 40-59 belonging to the Italian rural cohorts of the Seven Countries Study. During 25 years of follow-up 353 men developed a first event, that is a coronary death (sudden or not), and definite or possible myocardial infarction. Twenty-five partitioned proportional hazards models were solved, one for each independent year of follow-up, to predict the risk of incident events. Single-year hazard functions, separately for serum cholesterol and systolic blood pressure, were cumulated and smoothed. The resulting curves showed a regularly increasing risk for coronary events. They fit straight lines, with large correlation coefficients for both serum total cholesterol (r = 0.99) and systolic blood pressure (r = 0.99). These slopes were similar to the coefficients estimated by a single proportional hazards model solved for all events during 25 years. CONCLUSION: A single measurement of serum total cholesterol and systolic blood pressure in middle aged-men maintains a regular and monotonic relationship with occurrence of a first coronary event during 25 years of follow-up.
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First risk functions for prediction of coronary and cardiovascular disease incidence in the Gubbio Population Study.
BACKGROUND: The Gubbio study is an Italian population study which measures the risk factors and incidence of major cardiovascular diseases. This analysis produces multivariate models for the prediction of cardiovascular end-points. METHODS: A population sample of 2,963 men and women aged 35-74, free from major cardiovascular diseases, was examined in 1983 with risk factor measurement, and a 6-year incidence was computed for coronary heart disease and all cardiovascular (atherosclerotic) events. Proportional hazards models were solved for the prediction of these events. RESULTS: Over a 6-year period, 74 hard criteria, and 126 any criterion coronary heart disease and 174 cardiovascular events were recorded. Multivariate models showed the predictive power of sex (relative risk ranging 1.63 to 2.60), age (relative risk for 5-year difference ranging 1.38 to 1.48), systolic blood pressure (relative risk for 20 mmHg difference ranging 1.17 to 1.27), HDL cholesterol (relative risk for a difference of 10 mg/dl ranging 0.73 to 0.81), non-HDL cholesterol (relative risk for 40 mg/dl difference ranging 1.15 to 1.27), cigarette smoking (relative risk for 10 cigarette difference ranging 1.21 to 1.28), and body mass index (relative risk for 3 units ranging 0.99 to 1.02). All coefficients were statistically significant except that for body mass index, they were larger for hard criteria coronary heart disease, and their magnitude was similar to that found in previous Italian population studies. CONCLUSIONS: Traditional cardiovascular risk factors predict coronary and cardiovascular events in another Italian population study confirming previous findings and similar predictive models.
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Twenty-five-year cardiovascular disease incidence among middle-aged men. Disease burden, time shape, predictors, risk probabilities.
BACKGROUND: This analysis aims at describing the 25-year experience in cardiovascular incidence in a sample of middle-aged men in rural Italy. METHODS: A total of 1712 men aged 40-59 years were examined in 1960 in two rural Italian cohorts belonging to the Seven Countries Study. Major risk factors were measured and a monitoring system for incidence of cardiovascular events was in operation for the next 25 years centered on the first event occurring within each subgroup of cardiovascular diseases. Data were modeled by the Weibull distribution incorporated in the accelerated failure time model. RESULTS: Among 1695 cardiovascular disease-free men at entry, 51.3% experienced at least one cardiovascular event, the first being a coronary heart disease (35.6%), a cerebrovascular disease (17.8%) or a peripheral artery disease (13.0%). Among all first events the most common was intermittent claudication (17.6%), followed by angina pectoris (16.6%). A proportion of 13% of all initial episodes was rapidly fatal, whereas 38 % of subjects developing a cardiovascular event died within the 25-year deadline. Age, cigarette smoking, diabetes, corneal arcus, serum cholesterol, systolic blood pressure, and vital capacity fed into the accelerated failure time model showed a statistically significant association with cardiovascular disease incidence (inverse for vital capacity). The same model provided the shape of hazard during the 25 years with major events continuing to appear in an increasing exponential fashion, while soft criteria events were less likely to appear as a first event in the late phase of follow-up. CONCLUSIONS: In middle-aged men 25-year incidence of cardiovascular diseases is high and more relevant compared to that of traditional hard criteria coronary heart disease that in the past has attracted almost exclusive interest.
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[The use of coronary risk charts].
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Adult↗
Role of body mass index in the prediction of all cause mortality in over 62,000 men and women. The Italian RIFLE Pooling Project. Risk Factor and Life Expectancy.
STUDY OBJECTIVE: To evaluate the relation of body mass index (BMI) to short-term mortality in a large Italian population sample. DESIGN: Within the Italian RIFLE pooling project, BMI was measured in 47 population samples made of 32,741 men and 30,305 women ages 20-69 years (young 20-44, mature 45-69). Data on mortality were collected for the next six years. MAIN OUTCOME MEASURES: Age adjusted death rates in quintile classes of BMI and Cox proportional hazards models with six year all causes mortality as end point, BMI as covariate and age, smoking, systolic blood pressure as possible confounders were computed. Multivariate analysis was tested in all subjects and after the exclusion of smokers, early (first two years) deaths, and both categories. RESULTS: The univariate analysis failed to demonstrate in all cases a U or inverse J shaped relation. The Cox coefficients for the linear and quadratic terms of BMI proved significant for both young and mature women. The minimum of the curve was located at 27.0 (24.0, 30.0, 95% confidence limits, CL) and 31.8 (25.5, 38.2, 95% CL) units of BMI, for young and mature women respectively. Similar findings were obtained even when exclusion were performed. No relation was found for young men while for mature adult men only the model for all subjects retained significant curvilinear relation (minimum 29.3; 22.4, 36.2, 95% CL). CONCLUSION: These uncommon high values of BMI carrying the minimum risk of death seems to be in contrast with weight guidelines. A confirmation of these findings in other population groups might induce the consideration of changes in the suggested healthy values of BMI.
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[The prevalence and clinical characteristics of heart failure in a population sample of Calabria].
Two-hundred and fourteen patients with congestive heart failure were identified over a six-month period in the general practice of 29 GPs covering an adult population of 29,959 subjects residing in the region of Calabria, in southern Italy, with an overall prevalence of 7 per 1000. Males represented 52% of the cases and females 48%, with a median age of 75 years. On average, the condition was first diagnosed 41 months before the present examination. Patients generally had a high body mass index (28 kg/m2). Patients were classified as follows in the NYHA classification: 9.4% in class I, 45.3% in class II, 39.2% in class III, 6.1% in class IV. Hypertension, either alone or associated with ischemic heart disease (totally about 75% of cases), was the most common etiology, while COPD was the most commonly associated chronic condition. Clinical symptoms and signs were used to classify patients in a simplified version of the Boston score which was reported in 48% of cases as definite, 12% as possible, 6% as improbable and 34% as absent. A specific treatment was already ongoing in 97% of patients. The most commonly administered drugs were diuretics (83%), ACE-inhibitors (77%), and digitalis (67%). This three-drug combination (alone or with other drugs) covered 46% of patients. A comparison of four predefined typologies of treatment against the Boston score suggested that at least part of the outcome in classifying patients using this procedure was due to pathomorphosis of the syndrome induced by early pharmacological treatment.
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Comparison of multivariate predictive power of major risk factors for coronary heart diseases in different countries: results from eight nations of the Seven Countries Study, 25-year follow-up.
BACKGROUND: It was hypothesized that among eight national groups of men aged 40-59 years enrolled in the Seven Countries Study, the multivariate coefficients of major risk factors predicting coronary heart disease mortality over 25 years would be relatively similar. MATERIALS AND METHODS: Sixteen cohorts were located in eight nations and pooled, comprising one cohort in the USA, two in Finland, one in the Netherlands, three in Italy, two in Croatia (former Yugoslavia), three in Serbia (Yugoslavia), two in Greece and two in Japan, for a total of over 12000 subjects at entry. Coronary heart disease (CHD) mortality was defined as fatal myocardial infarction or sudden coronary death, and proportional hazard models were solved, for each country, with age, serum cholesterol level, systolic blood pressure and cigarette consumption as covariates. RESULTS: The relationships between risk factors and CHD mortality were statistically significant for all risk factors and for all countries, except for age in Croatia and Japan, cholesterol in Croatia and Japan, systolic blood pressure in Serbia and Greece, and cigarette-smoking in the Netherlands, Croatia, Serbia and Greece. When comparing all pairs of coefficients (28 comparisons for each factor) significant differences were found on four occasions for age, on six occasions for cholesterol, on no occasion for blood pressure and on four occasions for cigarette-smoking. Other tests suggested a substantial homogeneity among multivariate coefficients. Estimates for pooled coefficients were: age, in years, 0.0570 (95% confidence limits 0.0465 and 0.0673); relative risk for 5 years 1.33 (95% confidence limits 1.26 and 1.40); serum cholesterol level in mg/dl, 0.0057 (95% confidence limits 0.0045 and 0.0069); relative risk for 40 mg/dl 1.31 (95% confidence limits 1.20 and 1.31); systolic blood pressure in mmHg, 0.0160, (95% confidence limits 0.0134 and 0.0185), relative risk for 20 mmHg 1.38 (95% confidence limits 1.31 and 1.45); cigarettes per day, 0.0220 (95% confidence limits 0.0170 and 0.0272); relative risk for 10 cigarettes per day 1.25 (95% confidence limits 1.18 and 1.31). CONCLUSIONS: Great similarities were found in the multivariate coefficients of major coronary risk factors to CHD risk derived from population samples varying in CHD frequency.
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Twenty-five year mortality from coronary heart disease and its prediction in two Croatian cohorts of middle-aged men.
Two cohorts of men aged 40-59 in geographically defined areas of Croatia, former Yugoslavia, were enrolled in 1958 and cardiovascular risk factors were measured. The cohort of Dalmatia, on the Adriatic coast, was made up of 671 men (participation rate 98%), that of Slavonia, in the inland plain, of 696 men (participation rate 91%). Similar examinations were repeated 5 and 10 years after the entry one. A complete follow-up for vital status and causes of death was run for 25 years. Death rates in 25 years from coronary heart disease (CHD) were 90 per 1000 in Dalmatia and 148 per 1000 in Slavonia where also all other major causes of death and all-cause mortality rates were higher (642 vs 465 per 1000 in 25 years). Univariate and multivariate analysis relating ten risk factors to CHD mortality, showed that age and systolic blood pressure were significant predictors in Dalmatia; age, subscapular skinfold and body mass index (inverse) in Slavonia; and age, systolic blood pressure and subscapular skinfold in a multivariate model with lumped cohorts, where dummy variables identifying cohorts indicated a large unexplained extra-risk in Slavonia. In the pooled analysis cigarette smoking and serum cholesterol carried non significant coefficients. Blood pressure change in the first 10 years of follow-up added predictivity to a model exploring the delayed CHD morality occurring between year 10 and 25 of follow-up. Among the base-line measurements only serum cholesterol was significantly different between the two groups (188 mg/dl in Dalmatia and 199 mg/dl in Slavonia).(ABSTRACT TRUNCATED AT 250 WORDS)
Cohort Studies↗