Abstract
EPIC-Heart is the cardiovascular component of the European Prospective Investigation into Cancer and Nutrition (EPIC), a multi-centre prospective cohort study investigating the relationship between nutrition and major chronic disease outcomes. Its objective is to advance understanding about the separate and combined influences of lifestyle (especially dietary), environmental, metabolic and genetic factors in the development of cardiovascular diseases by making best possible use of the unusually informative database and biological samples in EPIC. Between 1992 and 2000, 519,978 participants (366,521 women and 153,457 men, mostly aged 35–70 years) in 23 centres in 10 European countries commenced follow-up for cause-specific mortality, cancer incidence and major cardiovascular morbidity. Dietary information was collected with quantitative questionnaires or semi-quantitative food frequency questionnaires, including a 24-h dietary recall sub-study to help calibrate the dietary measurements. Information was collected on physical activity, tobacco smoking, alcohol consumption, occupational history, socio-economic status, and history of previous illnesses. Anthropometric measurements and blood pressure recordings were made in the majority of participants. Blood samples were taken from 385,747 individuals, from which plasma, serum, red cells, and buffy coat fractions were separated and aliquoted for long-term storage. By 2004, an estimated 10,000 incident fatal and non-fatal coronary and stroke events had been recorded. The first cycle of EPIC-Heart analyses will assess associations of coronary mortality with several prominent dietary hypotheses and with established cardiovascular risk factors. Subsequent analyses will extend this approach to non-fatal cardiovascular outcomes␣and to further dietary, biochemical and genetic factors.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Riboli E, Hunt KJ, Slimani N, et al. (2002) European Prospective Investigation into Cancer and Nutrition (EPIC): Study populations and data collection. Public Health Nutr 5(6B):1113–124
Bingham S, Riboli E (2004) Diet and cancer — the European Prospective Investigation into Cancer and Nutrition. Nat Rev Cancer 4(3):206–15
Overvad K, Tjonneland A, Haraldsdottir J, Bang S, Ewertz M, Moller-Jensen O (1991) Development of a semi quantitative food frequency questionnaire to assess food, energy and nutrient intake in Denmark. Int J Epidemiol 20:906–12
Bingham SA, Gill C, Welch A, et al. (1994) Comparison of dietary assessment methods in nutritional epidemiology: Weighed records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br J Nutr 72(4):619–43
Margetts BM, Pietinen P (1997) European Prospective Investigation into Cancer and Nutrition: Validity studies on dietary assessment methods. Int J Epidemiol 26(Suppl 1):S1–S5
Riboli E, Elmstahl S, Saracci R, Gullberg B, Lindgarde F (1997) The Malmö Food Study: Validity of two dietary assessment methods for measuring nutrient intake. Int J Epidemiol 26(Suppl 1):S161–S173
Kroke A, Klipstein-Grobusch K, Voss S, et al. (1999) Validation of a self-administered food-frequency questionnaire administered in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: Comparison of energy, protein, and macronutrient intakes estimated with the doubly labeled water, urinary nitrogen, and repeated 24-h dietary recall methods. Am J Clin Nutr 70(4):439–47
Slimani N, Deharveng G, Charrondiere RU, et al. (1999) Structure of the standardized computerized 24-h diet recall interview used as reference method in the 22 centers participating in the EPIC project. European Prospective Investigation into Cancer and Nutrition. Comput Methods Programs Biomed 58(3):251–66
Slimani N, Ferrari P, Ocke M, et al. (2000) Standardization of the 24-hour diet recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): General concepts and preliminary results. Eur J Clin Nutr 54(12):900–17
Slimani N, Kaaks R, Ferrari P, et al. (2002) European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: Rationale, design and population characteristics. Public Health Nutr 5(6B):1125–145
Charrondiere R, Vignat J, Moller A, et al. (2002) The European Nutrient Database (ENDB) for nutritional epidemiology. J Food Comp Anal 15:435–51
Slimani N, Charrondiere R, Van Staveren WA, Riboli E (2000) Standardisation of food composition databases for the European Prospective Investigaion into Cancer and Nutrition (EPIC); general theoretical concept. J Food Comp Anal 13:567–84
Tormo MJ, Navarro C, Chirlaque MD, Barber X (2000) Validation of self diagnosis of high blood pressure in a sample of the Spanish EPIC cohort: Overall agreement and predictive values. EPIC Group of Spain. J Epidemiol Community Health 54(3):221–26
Haftenberger M, Lahmann PH, Panico S, et al. (2002) Overweight, obesity and fat distribution in 50- to 64-year-old participants in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5(6B):1147–162
Schulze MB, Kroke A, Saracci R, Boeing H (2002) The effect of differences in measurement procedure on the comparability of blood pressure estimates in multi-centre studies. Blood Press Monit 7(2):95–04
Appleby PN, Davey GK, Key TJ (2002) Hypertension and blood pressure among meat eaters, fish eaters, vegetarians and vegans in EPIC-Oxford. Public Health Nutr 5(5):645–54
Canoy D, Luben R, Welch A, et al. (2004) Fat distribution, body mass index and blood pressure in 22,090 men and women in the Norfolk cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Norfolk) study. J Hypertens 22(11):2067–074
Khaw KT, Bingham S, Welch A, et al. (2004) Blood pressure and urinary sodium in men and women: The Norfolk Cohort of the European Prospective Investigation into Cancer (EPIC-Norfolk). Am J Clin Nutr 80(5):1397–403
Psaltopoulou T, Orfanos P, Naska A, Lenas D, Trichopoulos D, Trichopoulou A (2004) Prevalence, awareness, treatment and control of hypertension in a general population sample of 26,913 adults in the Greek EPIC study. Int J Epidemiol 33(6):1345–352
Schulze MB, Kroke A, Bergmann MM, Boeing H (2000) Differences of blood pressure estimates between consecutive measurements on one occasion: Implications for inter-study comparability of epidemiologic studies. Eur J Epidemiol 16(10):891–98
Tormo MJ, Navarro C, Chirlaque MD, Barber X (2000) Is there a different dietetic pattern depending on self-knowledge of high blood pressure? Eur J Epidemiol 16(10):963–71
Berglund G, Elmstahl S, Janzon L, Larsson SA (1993) The Malmö diet and cancer study. Design and feasibility. J Intern Med 233(1):45–1
Boekholdt SM, Kuivenhoven JA, Wareham NJ, et al. (2004) Plasma levels of cholesteryl ester transfer protein and the risk of future coronary artery disease in apparently healthy men and women: The prospective EPIC (European Prospective Investigation into Cancer and nutrition)-Norfolk population study. Circulation 110(11):1418–423
Hedblad B, Nilsson P, Janzon L, Berglund G (2000) Relation between insulin resistance and carotid intima-media thickness and stenosis in non-diabetic subjects. Results from a cross-sectional study in Malmo, Sweden. Diabet Med 17(4):299–07
Hoffmann K, Heidemann C, Weikert C, Schulze MB, Boeing H (2006) Estimating the proportion of disease due to classes of sufficient causes. Am J Epidemiol 163(1):76–3
Jansson JH, Olofsson BO, Nilsson TK (1993) Predictive value of tissue plasminogen activator mass concentration on long-term mortality in patients with coronary artery disease. A 7-year follow-up. Circulation 88(5 Pt 1):2030–034
Johnsen SP, Hundborg HH, Sorensen HT, et al. (2005) Insulin-like growth factor (IGF) I, -II, and IGF binding protein-3 and risk of ischemic stroke. J Clin Endocrinol Metab 90(11):5937–941
Key TJ, Appleby PN, Davey GK, Allen NE, Spencer EA, Travis RC (2003) Mortality in British vegetarians: Review and preliminary results from EPIC-Oxford. Am J Clin Nutr 78(3 Suppl):533S-538S
Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N (2004) Association of hemoglobin A1c with cardiovascular disease and mortality in adults: The European prospective investigation into cancer in Norfolk. Ann Intern Med 141(6):413–20
Kok HS, van Asselt KM, van der Schouw YT, et al. (2006) Heart disease risk determines menopausal age rather than the reverse. J Am Coll Cardiol 47(10):1976–983
Mann JI, Appleby PN, Key TJ, Thorogood M (1997) Dietary determinants of ischaemic heart disease in health conscious individuals. Heart 78(5):450–55
Panico S, Celentano E, Galasso R, et al. (2003) Dietary Pattern and Ischemic heart disease incidents in female population of a mediterranean country; findings from EPIC-Italy Collaboration. Circulation 108(Supp IV):737
Rubba P, Panico S, Bond MG, et al. (2001) Site-specific atherosclerotic plaques in the carotid arteries of middle-aged women from southern Italy: Associations with traditional risk factors and oxidation markers. Stroke 32(9):1953–959
Thogersen AM, Jansson JH, Boman K, et al. (1998) High plasminogen activator inhibitor and tissue plasminogen activator levels in plasma precede a first acute myocardial infarction in both men and women: Evidence for the fibrinolytic system as an independent primary risk factor. Circulation 98(21):2241–247
Tolstrup J, Jensen MK, Tjonneland A, Overvad K, Mukamal KJ, Gronbaek M (2006) Prospective study of alcohol drinking patterns and coronary heart disease in women and men. Br Med J 332(7552):1244–248
van der A DL, Marx JJ, Grobbee DE, et al. (2006) Non-transferrin-bound iron and risk of coronary heart disease in postmenopausal womenCirculation 113(16):1942–949
Weikert C, Hoffmann K, Dierkes J, et al. (2005) A homocysteine metabolism-related dietary pattern and the risk of coronary heart disease in two independent German study populations. J Nutr 135(8):1981–988
Vaessen SF, Schaap FG, Kuivenhoven JA, et al. (2006) Apolipoprotein A–V, triglycerides and risk of coronary artery disease: The prospective EPIC-Norfolk Population Study. J Lipid Res 47(9):2064–070
Boekholdt SM, Sandhu MS, Wareham NJ, Luben R, Reitsma PH, Khaw KT (2006) Fibrinogen plasma levels modify the association between the factor XIII Val34Leu variant and risk of coronary artery disease: The EPIC-Norfolk prospective population study. J Thromb Haemost 4(10):2204–209
van der A DL, Peeters PH, Grobbee DE, et al. (2006) HFE mutations and risk of coronary heart disease in middle-aged women. Eur J Clin Invest 36(10):682–90
Acknowledgements
The following individuals have also contributed to EPIC-Heart: Aurelio Barricarte, Franco Berrino, J.␣Beulens, Paolo Boffetta, Hendriek Boshuizen, Michiel Bots, M.D. Chirlaque, Miren Dorronsoro, Bo Hedblad, Emmanuelle Kesse, Kerstin Klipstein-Grobusch, Jonas Manjer, Carmen Martinez, Domenico Palli, Petra Peeters, Fernando Rodriguez Artalejo, Joan Sabaté, Manj Sandhu, Nadeem Sarwar, M.J.␣Tormo, Ruth Travis, Hans Verhagen and Paolo Vineis.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Danesh, J., Saracci, R., Berglund, G. et al. EPIC-Heart: The cardiovascular component of a prospective study of nutritional, lifestyle and biological factors in 520,000 middle-aged participants from 10 European countries. Eur J Epidemiol 22, 129–141 (2007). https://doi.org/10.1007/s10654-006-9096-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-006-9096-8