The Seven Countries Study was the first to establish credible data
on incidence and death rates of CHD in contrasting cultures. The
study documented population differences in average levels and
distributions of coronary risk factors. It also demonstrated large
differences in composition of the diet in otherwise similar,
stable, rural agricultural or pastoral populations. Diet and
cigarette smoking explained most of the differences in population
CHD rates, while changes in serum cholesterol and blood pressure
levels between entry and 25-year follow-up examinations explained
much of the change in CHD death rates.
Results of the Seven Countries Study were crucial to the concept
of population causes, that is, the mass phenomena involved in the
genesis of coronary heart disease, and which influence widespread
individual and species susceptibility. Where environments are
unfavourable one finds maximal exhibition of coronary risk and a
heavy population disease burden. Where favourable, individual
(genetic) susceptibility is attenuated. This concept developed from
the Seven Countries study design that combined, for the first time,
a population and an individual approach. The study was realised
trough effective collaboration established among clinicians,
epidemiologists and nutritionists from Europe, the U.S.A., and
Japan.
Implications: The Seven Countries Study has played a central
role in the population strategy of heart disease prevention and
health promotion, complementing traditional medical strategies. It
contributed to the notion that major risk factors universally
predict individual risk. Cultures as well as individuals were found
to differ greatly in absolute risk of a coronaryevent at any level
of single or combined risk factors, presumably due to different
duration of risk exposure, different gene-environment interactions,
and to factors not yet known. Intervention strategy is therefore
best determined by absolute risk. Finally, the medical, public
health, and nutrition community, as well as agribusiness
internationally, have been profoundly influenced by the Seven
Countries Study in their recommendations, toward more healthy
eating patterns.
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