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European prospective investigation of ischaemic heart disease and nutrition

Objectif

- To investigate the relationship between diet and fatal myocardial infarction, as an expression of ischaemic heart disease (IHD) in nineteen cohorts in nine European countries (Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, United Kingdom);
- To obtain this information in the same cohorts enrolled - for the purpose of studying the relationships between nutrition and cancers at major sites - in the European Prospective Investigation into Cancer and Nutrition (EPIC) and associated studies coordinated by the International Agency for Research on Cancer, this being of considerable public health relevance for deriving overall dietary recommendations.

The direct objective of the EPIC-HEART project is to investigate the relationship between diet and fatal myocardial infarction, as an expression of ischaemic heart disease (IHD), in nineteen cohorts in nine European countries (Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, United Kingdom) enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC) and associated studies, coordinated by the International Agency for Research on Cancer, already including nearly 200 000 subjects, the largest ongoing prospective study of any kind in Europe.

In addition to investigating the role of all main foods and nutrients the study focuses in particular on:
(a) foods and food patterns as typically represented in Mediterranean diets rich in fresh fruits and vegetables, grains and cereals;
(b) alcoholic drinks;
(c) two groups of nutrients, namely: (i) long-chain polyunsaturated fats of the omega-3 family, in particular alfa-linolenic an eicosapentenoic fatty acid, and (ii) antioxidants, in particular vitamin C, alfa-tocopherol, retinoids and selenium as well as the antioxidant profile (e.g. the relative concentrations of different antioxidants).

Indirect objectives of the project are, first, to obtain information on the role of dietary components on myocardial infarction in the same European cohorts in which studies on cancers at major sites are already planned within the EPIC project, this being of considerable public health relevance for deriving dietary recommendations; and, second, to activate a group of collaborating European scientists to carry, within the same cohorts, furthermore specialized studies on IHD, for instance on the interaction of dietary components with susceptibility genes.

To attain these objectives, healthy volunteers have been enrolled in nineteen different cohorts and information collected at baseline by questionnaires on diet (in detail) tobacco smoking, occupation, education, socioeconomic status, life status of parents and siblings and, for women, reproductive history and contraceptive and hormone use; anthropometric and blood pressure measurement shave been taken, and plasma, serum, red cells and buffy coat samples collected for long term storage in liquid nitrogen. These subjects are followed for mortality and the end of 1997 expects more than 300 fatal cases of myocardial infarction. Baseline nutritional and other variables, including a number of biomarkers determinations pertinent to the direct objectives listed above, will be related to fatal myocardial infarction by means of analyses within cohorts (e.g. between subjects), between cohorts and between countries. To maximize inter-country comparability a novel procedure for calibration of dietary measurements has been developed within the EPIC project and will be applied in the EPIC-HEART project. KEYWORDS (max 10): Prospective study, nutrition, diet, EPIC, ischaemic heart disease, myocardial infarction.

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INTERNATIONAL AGENCY FOR RESEARCH ON CANCER
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