The ATTICA epidemiological study (Attica is the name of the region in central Greece the study took place) is a general population-based, prospective cohort, with three follow-up waves at 5, 10, and 20 years after baseline examination . The study was established by the First Cardiology clinic of Athens University Medical School in 2001-2002 and continued by the School of Health Sciences & Education, of Harokopio University in Athens. Study's supervisor(s) : Prof Demosthenes Panagiotakos, Prof Christos Pitsavos
Goals of the study
The primary objective of the study was to record sociodemographic, anthropometric, lifestyle, clinical, and biochemical characteristics of a representative sample of non-institutionalized, CVD- and cancer-free adults, and explore their longitudinal association with the development of fatal or non-fatal CVD.
Detailed information about the study aims, design, sampling procedure, and methodology can be found in previously published papers.
Bioethics
The study was conducted in accordance with the principles of the Declaration of Helsinki of the World Medical Association and approved by the Ethics Committee of the First Cardiology Department of the University of Athens (#017/01.05.2001) and Harokopio University (#38/29.03.2022).
Sample
The study's sample consisted of men and women living in the province of Attica, Greece (78% urban cities including Athens, the capital city of the country). Based on a random sampling procedure stratified by age, sex, and region (according to 2001 census), a total of 4,056 subjects (18+ years old) were invited to participate, from May 2001 to August 2002; of those, 3,042 (1,514 men, mean (SD) aged 46(13) years and 1,528 women, mean (SD) aged 45(13) years) agreed to participate.
Participants were evaluated, at baseline, as well as at follow-up examinations, at their home or workplace through face-to-face interviews by trained health professionals, including general practitioners, nurses, dietitians-nutritionists and cardiologists, using a standardized protocol (see details below).
Follow-up evaluation
During the 20-year follow-up period, 873 participants were lost (i.e., could not be reached due to missing/incorrect contact information or they declined to participate); thus, 2,169 were re-evaluated (71% participation rate); however, for the purpose of the present analyses, the final sample consisted of 1,988 participants who had complete CVD follow-up data (987 men, mean (SD) age of 45(13) years, 1,001 women, mean (SD) age of 43(14) years). All follow-up examinations included information on the development and management of hypercholesterolemia, hypertriglyceridemia, hypertension, and diabetes mellitus, the onset of non-fatal and fatal CVD event (i.e., myocardial infarction, angina pectoris, other identified forms of ischemia; coronary revascularization (i.e., coronary artery bypass surgery and percutaneous coronary intervention), heart failure of different types, and chronic arrhythmias; ischaemic stroke, or transient ischaemic attack), as well as participants' vital status (death from any cause), according to the 10th WHO International Coding of Disease classification (ICD-10). Physicians of the study confirmed the clinical diagnosis of the patients after assessing their medical records.
Publications
The findings from the Attica study have been reported in 200+ peer-reviewed publications in 70+ International scientific journals; a detailed list may be found here. Study's publications achieved 30.000+ citations; h-index 58 (2023) | 1.500+ presentations in national and International Conferences (including ESC, ACC, AHA, IAS, EAS).
Impact of the Study
3.042 participants | 3 follow-up examinations (2006, 2012, 2022) | 35.763 person-years of observation | 1.536 factors measured | 15+ PhD thesis | 180+ interviews in Media around the world.
International collaborations
The study is a member of :
Global Burden of Disease (GBD) | WHO project. A consistent and comparative description of the burden of diseases and injuries and the risk factors that cause them, worldwide.
The Emerging Risk Factors Collaboration (ERFC) | Department of Public Health and Primary Care, Cambridge University, UK. Analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of CVD.
NCD Risk Factor Collaboration (NCD-RisC) | WHO project. A network of health scientists around the world that provides rigorous and timely data on major risk factors for non-communicable diseases for all of the world's countries. The aim of this consortium is to estimate country/regional trends in major cardio-metabolic risk factors for non-communicable diseases (NCDs), globally; these include body mass index, cholesterol, blood pressure and glucose.
Global Cardiovascular Risk Consortium (GCVC). The Global Cardiovascular Risk Consortium analyzed a global harmonized individual-level dataset of population-based cohorts to overcome the limitations of summary data and methodological heterogeneity. In total, individual-level data from 1,518,028 individuals in 112 cohort studies conducted in eight geographic regions (North America, Latin America, Western Europe, Eastern Europe and Russia, North Africa and Middle East, sub-Saharan Africa, Asia, and Australia) were analyzed.