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24The origin and its developments
25 Blackburn-Keys Collection, University of Minnesota 
26
27The Seven Countries Study was conceived by Ancel Keys, a Minnesota physiologist, who in the mid-20th century brought together researchers from all over the world. It became a collective effort">
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34The origin and its developments
35 Blackburn-Keys Collection, University of Minnesota 
36
37The Seven Countries Study was conceived by Ancel Keys, a Minnesota physiologist, who in the mid-20th century brought together researchers from all over the world. It became a collective effort">
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118<div class="fusion-megamenu-title"><span class="awb-justify-title">About the Seven Countries Study</span></div>
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120<p>The Seven Countries Study was conceived by Ancel Keys, a Minnesota physiologist, who in the mid-20th century brought together researchers from all over the world. It became a collective effort to study their joint questions about heart and vascular diseases among countries having varied traditional eating patterns and lifestyles.</p>
121<h3 class="icon_origin">Origin &amp; development</h3>
122<p><a class="icon_read-more" href="/about-the-study/">
122More about how the study was conceived and the two phases of cardiovascular and healthy ageing epidemiology,</a></p>
123</div>
124		</div></div>
125</li>
126<li id="menu-item-7799" class="menu-item menu-item-type-post_type menu-item-object-page current-menu-item page_item page-item-83 current_page_item menu-item-7799 fusion-megamenu-submenu menu-item-has-link fusion-megamenu-columns-3 col-lg-4 col-md-4 col-sm-4">
127<div class="fusion-megamenu-title"><a class="awb-justify-title" href="/about-the-study/"><span class="fusion-megamenu-icon"><i class="glyphicon fa-arrow-down fas" aria-hidden="true"></i></span>About the study</a></div>
128<div class="fusion-megamenu-widgets-container second-level-widget"><div id="text-23" class="widget widget_text">			<div class="textwidget">
129<h3 class="icon_history">History</h3>
130<p><a class="icon_read-more" href="/about-the-study/history">Read about half a century of scientific endeavor.</a></p>
131<h3 class="icon_design">Study design</h3>
132<p><a class="icon_read-more" href="/about-the-study/study-design">Find out how the research team obtained its data.</a></p>
133<h3 class="icon_measurements">Measurements</h3>
134<p><a class="icon_read-more" href="/about-the-study/measurements">Which medical, lifestyle and demographic factors were measured?</a></p>
135<h3 class="icon_countries">Countries</h3>
136<p><a class="icon_read-more" href="/about-the-study/countries">Learn about the countries and cohorts studied in the SCS.</a></p>
137</div>
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140<li id="menu-item-7797" class="menu-item menu-item-type-post_type menu-item-object-page current-menu-item page_item page-item-83 current_page_item menu-item-7797 fusion-megamenu-submenu menu-item-has-link fusion-megamenu-columns-3 col-lg-4 col-md-4 col-sm-4">
141<div class="fusion-megamenu-title"><a class="awb-justify-title" href="/about-the-study/">About the study</a></div>
142<div class="fusion-megamenu-widgets-container second-level-widget"><div id="text-24" class="widget widget_text">			<div class="textwidget">
143<h3 class="icon_investigators">Investigators</h3>
144<p><a class="icon_read-more" href="/about-the-study/investigators">Meet the driving forces behind the conduct of the SCS.</a></p>
145<h3 class="icon_related">Related studies</h3>
146<p><a class="icon_read-more" href="http://sevencountriesstudy.com/about-the-study/related-studie">Browse the other studies that sprouted from the SCS.</a></p>
147<h3 class="icon_sponsors">Sponsors</h3>
148<p><a class="icon_read-more" href="/about-the-study/sponsors">Scan the list of benefactors that made the SCS happen.</a></p>
149<h3 class="icon_coordination">Coordination</h3>
150<p><a class="icon_read-more" href="/about-the-study/coordination-and-databases/">Who ran the SCS and the cohorts?</a></p>
151</div>
152		</div></div>
153</li>
154</ul></div>
155<div style="clear:both;"></div>
156</div></div>
157</li>
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159<a href="/about-the-study/countries/" class="fusion-flex-link fusion-bottombar-highlight"><span class="fusion-megamenu-icon"><i class="glyphicon fa-globe-europe fas fa-fw" aria-hidden="true"></i></span><span class="menu-text">Countries</span></a><div class="fusion-megamenu-wrapper fusion-columns-2 columns-per-row-2 columns-2 col-span-12 fusion-megamenu-fullwidth"><div class="row">
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162<div class="fusion-megamenu-title"><a class="awb-justify-title" href="/about-the-study/countries/country-trends/">The 7 countries</a></div>
163<div class="fusion-megamenu-widgets-container second-level-widget"><div id="text-25" class="widget widget_text">			<div class="textwidget">
164<p>The cohorts in the Seven Countries were chosen as cultures apparently contrasting in lifestyle, eating habits and risk factor levels.</p>
165<p><a class="icon_read-more" href="/about-the-study/countries">Learn about the selection process.</a></p>
166<p><a href="/about-the-study/countries"><img fetchpriority="high" decoding="async" src="/wp-content/uploads/Seven-countries-cohorts-menu.png" alt="" width="450" height="275" class="alignnone size-full wp-image-7993" srcset="/wp-content/uploads/Seven-countries-cohorts-menu-200x122.png 200w, /wp-content/uploads/Seven-countries-cohorts-menu-400x244.png 400w, /wp-content/uploads/Seven-countries-cohorts-menu.png 450w" sizes="(max-width: 450px) 100v
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171<div class="fusion-megamenu-title"><a class="awb-justify-title" href="/about-the-study/countries/"><span class="fusion-megamenu-icon"><i class="glyphicon fa-map-signs fas" aria-hidden="true"></i></span>Intro</a></div>
172<div class="fusion-megamenu-widgets-container second-level-widget"><div id="text-26" class="widget widget_text">			<div class="textwidget">
173<h3 class="icon_navigation">The 7 Countries</h3>
174<ul class="fancy_list">
175<li><a title="Countries – USA" href="/about-the-study/countries/countries-usa">USA</a></li>
176<li><a title="Countries – Finland" href="/about-the-study/countries/countries-finland">Finland</a></li>
177<li><a title="Countries – Netherlands" href="/about-the-study/countries/countries-netherlands">Netherlands</a></li>
178<li><a title="Countries – Italy" href="/about-the-study/countries/countries-italy">Italy</a></li>
179<li><a title="Countries – Greece" href="/about-the-study/countries/countries-greece">Greece</a></li>
180<li><a title="Countries – Yugoslavia" href="/about-the-study/countries/countries-yugoslavia">Former Yugoslavia</a></li>
181<li><a title="Countries – Japan" href="/about-the-study/countries/countries-japan">Japan</a></li>
182</ul>
183<h3 class="icon_trends">Country Trends</h3>
184<p><a class="icon_read-more" href="/about-the-study/countries/country-trends">Explore the graphs with trends in CVD risk factors across time and cultures.</a></p>
185</div>
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192<li id="menu-item-7794" class="menu-item menu-item-type-post_type menu-item-object-page menu-item-7794" data-item-id="7794"><a href="/about-the-study/investigators/" class="fusion-flex-link fusion-bottombar-highlight"><span class="fusion-megamenu-icon"><i class="glyphicon fa-user-friends fas fa-fw" aria-hidden="true"></i></span><span class="menu-text">Investigators</span></a></li>
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194<a href="/study-findings/" class="fusion-flex-link fusion-bottombar-highlight fusion-has-highlight-label"><span class="fusion-megamenu-icon"><i class="glyphicon fa-folder-open fas fa-fw" aria-hidden="true"></i></span><span class="menu-text">Study findings<span class="fusion-menu-highlight-label" style="background-color:#f2dcc5;color:#000000;">84 main results</span></span></a><div class="fusion-megamenu-wrapper fusion-columns-3 columns-per-row-3 columns-3 col-span-12 fusion-megamenu-fullwidth"><div class="row">
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197<div class="fusion-megamenu-title"><a class="awb-justify-title" href="/study-findings/">Study findings</a></div>
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199<p>With hundreds of peer-reviewed publications, the Seven Countries Study generated an incredible amount of information. We&#8217;ve selected 84 main results and summarized them for you in our articles.</p>
200</div>
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204<div class="fusion-megamenu-title"><a class="awb-justify-title" href="/study-findings/coronary-heart-disease/">Early associations</a></div>
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206<h3 class="icon_cross">Cross-cultural findings</h3>
207<p>See the associations between diet, risk factors and coronary heart disease rates in the 16 cohorts of the Seven Countries Study</p>
208<p><a class="icon_read-more" href="/about-the-study/cross-cultural">Early associations between cultures</a></p>
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210<h3 class="icon_trends">Country Trends</h3>
211<p>Explore the graphs with trends in CVD risk factors across time and cultures.</p>
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306			<span class="entry-title rich-snippet-hidden">About the study</span>
307			
308			<div class="post-content">
309				<h1>About the study</h1>
310<h2>The origin and its developments</h2>
311<div id="attachment_2066" style="width: 140px" class="wp-caption alignright">
312<a href="/about-the-study/investigators/ancel-keys"><img decoding="async" aria-describedby="caption-attachment-2066" class="size-full wp-image-2066 " title="Learn more about Ancel Keys" src="/wp-content/uploads/2012/07/Ancel-Keys-small.jpg" alt="Ancel Keys" width="130" height="170"></a><p id="caption-attachment-2066" class="wp-caption-text">Blackburn-Keys Collection, University of Minnesota</p>
313</div>
314<p>The Seven Countries Study was conceived by Ancel Keys, a Minnesota physiologist,&nbsp;who in the mid-20<sup>th</sup> century&nbsp;brought together researchers from all over the world. It became a collective effort to study their joint questions about heart and vascular diseases among countries having varied traditional eating patterns and lifestyles. <a title="History" href="/about-the-study/history">More about the history of the study.</a></p>
315<h2>Hypothesis</h2>
316<p>The main hypothesis was that the rate of coronary disease in populations and individuals would vary in relation to their physical characteristics and lifestyle, particularly in fat composition of the diet and <span data-tooltip="Serum cholesterol: A value indicating the amount of cholesterol in the blood serum." class="glossaryLink">serum cholesterol</span> levels.</p>
317<h2>Objective</h2>
318<p>The objective was to explore in detail the associations of diet, other <span data-tooltip="Risk factor: An aspect of personal behavior or lifestyle, an environmental exposure, or an inborn or inherited characteristic that, on the basis of scientific evidence, is known to be associated with meaningful health-related condition(s). It&rsquo;s not necessarily a causal factor: it may be a risk marker, merely indicating a greater&nbsp;risk caused by something else." class="glossaryLink">risk factors</span>, and disease rates between populations and among individuals within populations, using standard measures by trained&nbsp;survey teams, with blindfolded coding and analysis of data.</p>
319<h2>Pilot study evidence</h2>
320<p>Informal exploratory studies in Italy, Spain, South Africa, and Jap
320an from 1952 to 1956 suggested that diets, serum cholesterol levels, and heart attack rates varied widely and that methods needed to be standardized. More formal pilot studies were undertaken from 1956 to 1957 in Finland, Italy, and Greece indicating that a desirable wide range of diets and disease rates probably existed and that staff and populations could be effectively recruited and examined.</p>
321<h2>A three-part endeavour</h2>
322<h3>Timeline</h3>
323<a class="awb-lightbox awb-lightbox-1" href="/wp-content/uploads/2013/03/SCS_Timeline.gif" data-rel="iLightbox"><img decoding="async" src="/wp-content/uploads/2013/03/SCS_Timeline.gif"></a>
324<h3>The early period of cardiovascular disease epidemiology</h3>
325<p>During the first phase of the study (1958-1983), standardized lifestyle and <span data-tooltip="Risk factor: An aspect of personal behavior or lifestyle, an environmental exposure, or an inborn or inherited characteristic that, on the basis of scientific evidence, is known to be associated with meaningful health-related condition(s). It&rsquo;s not necessarily a causal factor: it may be a risk marker, merely indicating a greater&nbsp;risk caused by something else." class="glossaryLink">risk factor</span> surveys were carried out at <span data-tooltip="Baseline: A set of data collected at the beginning of a study." class="glossaryLink">baseline</span> and after 5 and 10 years of <span data-tooltip="Follow-up: Observation over a period of time of an individual, group, or an initially defined population whose appropriate characteristics have been assessed in order to observe changes in health status or health-related variables." class="glossaryLink">follow-up</span> in 16 cohorts of middle-aged men from seven countries. The surveys were executed by teams of the local principal investigators,&nbsp;who&nbsp;also collected the <span data-tooltip="Mortality: An estimate of the&nbsp;number for persons in&nbsp;a population who died&nbsp;in a specified period." class="glossaryLink">mortality</span> data during 25 years.</p>
326<h3>The second phase: the epidemiology of healthy aging</h3>
327<p>The second phase of the study, from 1984-1999, is characterized by extending the cardiovascular surveys about different aspects of health in the elderly from nine European cohorts. 50-year mortality data were collected up to 2014 in 13 of the 16 cohorts. In the Finland, Italy, Netherlands, Elderly (FINE) study (coordinated by Aulikki Nissinen, Alessandro Menotti and Daan Kromhout) standardized gerontologic surveys were carried out and supplemented by data from the Serbian and Crete cohorts. Only mortality data were collected in the SCS cohorts of the USA, Corfu and Japan. <a title="FINE study" href="/about-the-study/related-studie/fine-study">Read more about the FINE Study.</a> The data from the FINE study were combined with those of the SENECA study and the HALE (Healthy Aging a Longitudinal study in Europe) project lead by Daan Kromhout. <a href="/about-the-study/related-studie/hale-study">Read more about the HALE project.</a></p>
328<p><img decoding="async" class="size-full wp-image-2074 alignright" title="Zutphen study, May 2002" src="/wp-content/uploads/2012/07/zutphen-vendor.jpg" alt="Zutphen study, May 2002" width="230" height="178"></p>
329<h3>Unique longitudinal data on risk factors and diet collected in the Zutphen Study</h3>
330<p>Between 1960 and 1973 cardiovascular risk factors of the Zutphen men were examined&nbsp;yearly. The Zutphen <span data-tooltip="Cohort: Any designated group of persons that is studied over a period of time (as in a cohort study), so that its characteristics (e.g., causes of death and numbers still living) can be determined as time and age unravels." class="glossaryLink">cohort</span> also was the only one in which seven dietary surveys were carried out between 1960 and 2000. This made possible&nbsp;detailed studies on risk factors, diet, <span data-tooltip="Cardiovascular disease (CVD): Any disease that affects the heart or blood vessels (arteries, capillaries and veins), principally cardiac disease, vascular diseases of the brain, and peripheral arterial disease." class="glossaryLink">cardiovascular disease</span> and different aspects of health. <a href="/about-the-study/related-studie/zutphen-study">Read more about the Zutphen Study.</a></p>
331<h2>What we learned from the Seven Countries Study</h2>
332<p>The Seven Countries Study was a pioneering endeavour in study design that influenced and enhanced many studies to follow. It showed that serum cholesterol, <span data-tooltip="Blood pressure: Pressure exerted by the blood upon the walls of the blood vessels, especially arteries." class="glossaryLink">blood pressure</span>, diabetes and smoking are universal risk factors for <span data-tooltip="Coronary heart disease (CHD): A condition especially caused by atherosclerosis and thrombosis that reduces the blood flow through the coronary arteries to the heart muscle and typically results in chest pain or heart damage." class="glossaryLink">coronary heart disease</span>. Ancel Keys and his Italian colleague Flaminio Fidanza and their SCS colleagues were central to the modern recognition, definition, and promotion of the eating pattern they found in Italy and Greece in the 1950s and &rsquo;60s, now popularly called &ldquo;The Mediterranean Diet.&rdquo; They showed together with their colleagues that dietary patterns in the Mediterranean and in Japan in the 1960s were associated with low rates of coronary heart disease and <span data-tooltip="All-cause mortality:&nbsp;An estimate of the number of persons in a population who died from any cause in a specified period." class="glossaryLink">all-cause mortality</span>. The studies in the elderly showed that a healthy diet and lifestyle (sufficient physical activity, non-smoking and moderate alcohol consumption) also is associated with a low risk of cardiovascular disease and all-cause mortality. A healthy diet and sufficient physical activity may also postpone <span data-tooltip="Cognitive decline: The deterioration of mental processes like memory,&nbsp;learning, language, thinking and judgment." class="glossaryLink">cognitive decline</span> and decrease the risk of depression.</p>
333<h3>The Seven Countries Study provided evidence&hellip;</h3>
334<ul>
335<li>for the concept of sick and healthy populations</li>
336<li>that the major cardiovascular risk factors are universal</li>
337<li>for the diet-heart hypothesis</li>
338<li>that cardiovascular disease is preventable</li>
339<li>that a healthy lifestyle may promote different aspects of health</li>
340</ul>
341<div class="fancy-list-arrow"><a href="/study-findings">Go to study findings</a></div>
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348<div class="heading"><h4 class="widget-title">The Seven Countries Study</h4></div>			<div class="textwidget">
349<h3 class="icon_origin">Origin &amp; development</h3>
350<p><a class="icon_read-more" href="/about-the-study/">
350More about how the study was conceived and the two phases of cardiovascular and healthy ageing epidemiology,</a></p>
351<h3 class="icon_history">History</h3>
352<p><a class="icon_read-more" href="/about-the-study/history">Read about half a century of scientific endeavor.</a></p>
353<h3 class="icon_design">Study design</h3>
354<p><a class="icon_read-more" href="/about-the-study/study-design">Find out about the 3-part design of the study and its timeline.</a></p>
355<h3 class="icon_measurements">Measurements</h3>
356<p><a class="icon_read-more" href="/about-the-study/measurements">Which medical, lifestyle and demographic factors were measured?</a></p>
357<h3 class="icon_countries">Countries</h3>
358<p><a class="icon_read-more" href="/about-the-study/countries">Learn about the countries and cohorts studied in the SCS.</a></p>
359<h3 class="icon_investigators">Investigators</h3>
360<p><a class="icon_read-more" href="/about-the-study/investigators">Meet the driving forces behind the conduct of the SCS.</a></p>
361<h3 class="icon_related">Related studies</h3>
362<p><a class="icon_read-more" href="http://sevencountriesstudy.com/about-the-study/related-studie">Browse the other studies that sprouted from the SCS.</a></p>
363<h3 class="icon_sponsors">Sponsors</h3>
364<p><a class="icon_read-more" href="/about-the-study/sponsors">Scan the list of benefactors that made the SCS happen.</a></p>
365<h3 class="icon_coordination">Coordination</h3>
366<p><a class="icon_read-more" href="/about-the-study/coordination-and-databases/">Who ran the SCS and the cohorts?</a></p>
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384<p>The Seven Countries Study is the first major study to investigate diet and lifestyle along with other risk factors for cardiovascular disease, across contrasting countries and cultures and over an extended period of time.</p>
385<p>We have results from over 50 years of follow-up.</p>
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396<li><a href="/tea-and-coronary-heart-disease/">Tea and cardiovascular disease</a></li>
397<li><a title="Chocolate and coronary heart disease" href="https://sevencountriesstudy.com/chocolate-and-coronary-heart-disease">Chocolate and cardiovascular disease</a></li>
398<li><a href="/ecg-predictors-and-coronary-heart-disease/">ECG predictors and CHD</a></li>
399<li><a href="/major-risk-factors-and-cardiovascular-disease/">Major risk factors and cardiovascular disease</a></li>
400<li><a href="/average-saturated-fat-intake-and-coronary-heart-disease-rates-in-the-16-cohorts/">Average saturated fat intake and 25-year coronary heart disease rates in the 16 cohorts</a></li>
401<li><a href="/trans-fat-and-coronary-heart-disease/">Trans fat and coronary heart disease</a></li>
402<li><a href="/dietary-patterns-and-all-cause-mortality/">Dietary patterns and all-cause mortality</a></li>
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410<li><a href="/about-the-study/investigators/ancel-keys/">Ancel Keys</a></li>
411<li><a href="/about-the-study/countries/">Countries and cohorts</a></li>
412<li><a href="/tag/mediterranean-diet/">The Mediterranean diet</a></li>
413<li><a href="/about-the-study/study-design/">Study design</a></li>
414<li><a href="/study-findings/cross-cultural/">Cross-cultural relationships</a></li>
415<li><a href="/about-the-study/countries/country-trends/">Country trends</a></li>
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421<p>The aim of the Seven Countries Study website is to recount and illustrate the history and contributions of the study, including outcomes about risk factors, diet, lifestyle and health.</p>
422<p>See also the <a href="http://www.epi.umn.edu/cvdepi/">History of Heart Attack Prevention Research website.</a></p>
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