Changes in 10-year cardiovascular risk and behavioral risk factors in men in Crete, Greece, since the Seven Countries’ Study (1960–1997)

Aim: The Seven Countries’ Study showed that in the 1960s, participants in the island of Crete, Greece, had among the lowest cardiovascular (CVD) mortality rates in the world, but in recent years CVD rates in Crete have increased. This study aimed to assess changes in CVD-risk occurring since the Seven Countries’ Study. Subject and methods: Secondary analysis was performed in two cohorts of men (aged 40–60 years) in Crete-Greece, in 1960 (Seven Countries’ Study’s participants) and 1997 (random sample of men of the same age and residence areas). The HeartScore was used to estimate the (1) 10-year CVD-risk and (2) 10-year CVD-risk based on body mass index (BMI), of 627 (1960 cohort) and 93 (1997 cohort) Cretan men. Results: Between 1960 and 1997, 10-year CVD-risk (3.4 vs. 4.7%, P < 0.001) and risk based on BMI (1.6 vs. 3.0%, P < 0.001) increased by 38 and 88%, respectively. During this period, the proportion of overweight/obese participants (21.8 vs. 83.9%, P < 0.001) and participants with hypercholesterolemia (51.5 vs. 81.7%, P < 0.001), as well as physical inactivity (37.3 vs. 56.0%, P = 0.001) increased. The prevalence of high and very high CVD-risk (≥5%) almost doubled (+90%), mainly due to concomitant increases in total cholesterol levels (+84%, P < 0.001) during this period. CVD-risk increased between 1960 and 1997 in this population of Cretan men. Conclusions: Appropriate public health initiatives are needed to promote the traditional, health-promoting lifestyle of men in Crete observed in the 1960s in the Seven Countries’ Study.