Twelve-year incidence of coronary heart disease in middle-aged adults during the era of hypertensive therapy: the Framingham offspring study

Article Abstract:

The number of deaths resulting from coronary heart disease (CHD) has been declining over the past two decades. The early detection of symptoms and the identification of risk factors associated with CHD have contributed to the decline in CHD-related mortality. The offspring (and their spouses) of the original participants in the Framingham Heart Study were studied. The purpose was to follow the life style and medical status of middle-aged adults in order to assess the prevalence of CHD and the risk factors associated with CHD. The offspring study included 1,663 men and 1,714 women, aged 30 to 59. Baseline measurements of blood pressure (systolic/diastolic), blood cholesterol and lipid levels, heart function, and cigarette smoking were collected from 1972 to 1974. These parameters were remeasured several times during the following 12 years and were compared with the baseline measurements. During the 12-year study period, 3.2 percent of the women and 9.4 percent of the men developed CHD. The average age for developing CHD was 44.6 years for the men and 47.2 years for the women. There were significant relationships between development of CHD and greater age, lower plasma levels of high density lipoprotein cholesterol (HDL-C), and a greater number of cigarettes smoked on a daily basis. Elevated plasma levels of low-density lipoprotein cholesterol (LDL-C) and fasting glucose levels were associated with CHD in men. When levels of HDL-C were taken into account, plasma triglyceride levels and very-low-density lipoprotein cholesterol (VLDL-C) levels were not related to the development of CHD. Fifty percent of the individuals with hypertension were being treated with blood pressure medications. In women only, elevated systolic blood pressure was associated with CHD. It is concluded that in these middle-aged subjects, elevated plasma levels of LDL-C, reduced plasma levels of HDL, and cigarette smoking are risk factors for the development of CHD. The successful treatment of hypertension has reduced the incidence of hypertension-related CHD in recent decades. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Hypertension, Development and progression, Smoking, Hypercholesterolemia, Longitudinal studies

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Epidemiology of some peripheral arterial findings in diabetic men and women: experiences from the Framingham study

Article Abstract:

It has been suggested that diabetes mellitus is a predisposing factor in the development of peripheral artery disease. Clinical evidence of peripheral artery disease includes carotid and femoral artery bruits (noises), as well as nonpalpable foot (pedal) pulses. This study, based on 20 years of follow-up on subjects who were originally enrolled in the Framingham Study, set out to determine the association between diabetes and clinical evidence of peripheral arterial disease and acute cardiovascular events. The cardiovascular events included stroke, coronary heart disease, and cardiac failure, and the study consisted of 1,196 men and 1,582 women. The results indicated that in patients without diabetes, the incidence of carotid bruits and nonpalpable foot pulses increased with age for both men and women. Diabetic patients were at risk for each condition, and this did not change with age group. In women with diabetes, the incidence of femoral bruits was twice that found in nondiabetic women. In the male subjects, the risk of carotid bruits was double in diabetics, compared with nondiabetics. An especially high risk for cardiovascular events was found in patients who had both diabetes and peripheral artery disease symptoms. Nonpalpable pedal pulses were associated with twice the incidence of heart disease and stroke in diabetic women, and a twofold incidence of heart disease and heart failure in diabetic men. In diabetic men, the presence of femoral bruits doubled the risk of heart disease. It is concluded that, although diabetes predisposes a patient to various kinds of peripheral artery disease, the risk of acute heart problems is increased when the peripheral artery disease is also apparent. Careful examination of the arterial circulation in these patients is important. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Diabetes, Diabetes mellitus, Arteries, Carotid artery, Carotid arteries

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Risk of coronary heart disease in subjects with chest discomfort: the Framingham Heart Study

Article Abstract:

Chest discomfort is a frequent complaint of people seeking medical care, but diagnosis is often difficult. In this study, chest pain was classified as angina pectoris if it was recurrent, under 15 minutes in duration, precipitated by exertion or emotion, relieved by rest or nitroglycerin, and if the site and character of the pain were appropriate. The risk of coronary heart disease (CHD) associated with anginal and non-anginal pain has not been studied in a general, unselected population. An evaluation was performed on 3,501 participants (2,049 female), average age 64 years, of the Framingham Heart study, who did not have a history of CHD to determine the relation between chest pain and CHD. The results showed that subjects whose chest pain indicated definite or possible angina were at increased risk for CHD events, while the incidence of CHD in patients with nonanginal chest pain was not different from that of subjects without chest pain. After adjusting for age and other risk factors, the risk for CHD events was similar for women and men. Remission of discomfort within two years occurred in 38 percent of patients with possible angina, while 11 percent subsequently developed definite angina within two years. The study suggests that patients with angina-like chest pain should be targeted for further diagnostic evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Chest pain, Angina pectoris

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