《Cardiovascular Epidemiology. Part II》由会员分享，可在线阅读，更多相关《Cardiovascular Epidemiology. Part II（43页珍藏版）》请在金锄头文库上搜索。
1、Lifetime Risk of Coronary Heart Disease in the Framingham StudyMen WomenAt age 40 years:48.6%31.7%At age 70 years:34.9%24.2%Lloyd-Jones et al. Lancet 1999; 353:89-92 Lloyd-Jones et al. Lancet 1999; 353:89-92 _First Coronary Events: Framingham Study Percent as Specified EventMyocardialMyocardialAngin
2、aAngina Sudden SuddenInfarctionInfarctionPectorisPectoris DeathDeathAgeAge Men Women Men Women Men WomenMen Women Men Women Men Women35-64 43%35-64 43% 28% 28% 41% 59% 41% 59% 9% 9%4%4%65-8465-84 55% 44% 55% 44% 28% 41% 28% 41% 11% 11%7.4%7.4%Framingham Study 44 year follow-up.Framingham Study 44 ye
3、ar follow-up._Estimated 10-Year CHD Risk in 55-Year-Old Adults According to Levels of Various Risk Factors Framingham Heart Study A A B B C C D DBlood Pressure (mm Hg)Blood Pressure (mm Hg)120/80120/80 140/90140/90 140/90140/90140/90140/90Total Cholesterol (mg/dL)Total Cholesterol (mg/dL)200200 240
4、240 240 240 240 240HDL Cholesterol (mg/dL) 50HDL Cholesterol (mg/dL) 50 50 50 40 40 40 40DiabetesDiabetes No No No No Yes Yes Yes YesCigarettesCigarettes No No No No No No Yes YesEstimated 10-Year Stroke Risk in 55-Year-Old Adults According to Levels of Various Risk Factors Framingham Heart StudyA A
5、B BC CD DE EF FSystolic BP*Systolic BP*95-10595-105130-148130-148 130-148130-148 130-148130-148 130-148130-148 130-148130-148DiabetesDiabetesNoNoNoNoYesYesYesYesYesYesYesYesCigarettesCigarettesNoNoNoNoNoNoYesYesYesYesYesYesPrior Atrial Fib.Prior Atrial Fib.NoNoNoNoNoNoNoNoYes Yes YesYesPrior CVDPrio
6、r CVDNoNoNoNoNoNoNoNoNoNoYesYesSource: Stroke 1991;22:312-318.*BP in millimeters of mercury (mmHg)A AB BC CD DE EF FSystolic BP*Systolic BP*95-10595-105130-148130-148 130-148130-148 130-148130-148 130-148130-148 130-148130-148DiabetesDiabetesNoNoNoNoYesYesYesYesYesYesYesYesCigarettesCigarettesNoNoNo
7、NoNoNoYesYesYesYesYesYesPrior Atrial Fib.Prior Atrial Fib.NoNoNoNoNoNoNoNoYes Yes YesYesPrior CVDPrior CVDNoNoNoNoNoNoNoNoNoNoYesYesEstimated 10-year stroke risk in 55-year-old adults Estimated 10-year stroke risk in 55-year-old adults according to levels of various risk factors according to levels
8、of various risk factors (FHS). (FHS). Source: Wolf et al., Stroke.1991;22:312-318.Source: Wolf et al., Stroke.1991;22:312-318.*BP in millimeters of mercury (mmHg)Offspring CVD Risk by Parental CVD Status: Framingham StudyRisk Ratio2.521.510.50MenWomen1.01.72.21.01.71.7Adjusted for: age, total/HDL Ch
9、ol. ratio, SBP, smoking, diabetes, BMIParental CVD 55 men, 65 WomenMultivariable RiskRisk imposed by a strong family history of heart attacks varies widely depending on the burden of modifiable risk factors 9Doubts about cholesterol as late as 1989Serum Serum CholesterolCholesterolAge: 35-64*Age: 35
10、-64*Age: 65-94Age: 65-94MenMenWomeWomen nMenMen+ +Women*Women*84-20484-2048 84 422221111205-234205-23413135 524241515235-264235-26414144 426261717265-294265-29415157 723231717295-1124295-11242626101038383232Risk of Coronary Heart Diseaseby Serum Cholesterol30-Year Follow-up, The Framingham Study*Tre
11、nds Significant at P .001. +P .07. Age-Adjusted Annual Rate per 1000Q = serum cholesterol quintile. Kannel WB et al. Am Heart J. 1986;112:825-836.Multiple Risk Factor Intervention Trial (MRFIT) N=325,346 Correlation Between Serum Cholesterol and CVD Mortality6-Year CVD Death Rate Per 100005101520253
12、0Q1(244)35-39 years40-44 years45-49 years50-54 years55-57 years Serum Cholesterol Quintile (mg/dL)Untreated PatientsLifetime Risk of CHD Increases with Serum CholesterolFramingham Study: Subjects age 40 yearsDM Lloyd-Jones et al Arch Intern Med 2003; 1966-1972344457192933Cholesterol_Age-adjusted pre
13、valence of Adults age 20 and older with LDL cholesterol of 130 mg/dL or higher, by race/ethnicity and sex (NHANES: 2003-2004). Source: NCHS and NHLBI. NH non-Hispanic.Age-adjusted prevalence of Adults age 20 and older with HDL cholesterol 40 mg/dL, by race/ethnicity and sex (NHANES: 2003-2004). Sour
14、ce: NCHS and NHLBI. NH non-Hispanic.Trends in mean total serum cholesterol among Trends in mean total serum cholesterol among adults age 20 and older, by race/ethnicity, sex and adults age 20 and older, by race/ethnicity, sex and survey survey (NHANES : 1988-94, 1999-02 and 2003-04). (NHANES : 1988-
15、94, 1999-02 and 2003-04). Source: NCHS and NHLBI. NH non-Hispanic.Source: NCHS and NHLBI. NH non-Hispanic.Trends in mean total blood cholesterol among Trends in mean total blood cholesterol among adolescents ages 12-17 by race, sex, and survey adolescents ages 12-17 by race, sex, and survey (NHES: 1
16、966-70; NHANES: 1971-74 and 1988-94). (NHES: 1966-70; NHANES: 1971-74 and 1988-94). Source: NCHS and NHLBI. Source: NCHS and NHLBI. CK Friedberg on Hypertension: Diseases of the Heart 1996 “There is a lack of correlation in most cases between the severity and duration of hypertension and development
17、 of cardiac complications.”_Relation of Non-Hypertensive Blood Pressure to Cardiovascular DiseaseVasan R, et al. N Engl J Med 2001; 345:1291-1297Vasan R, et al. N Engl J Med 2001; 345:1291-129710-year Age- Adjusted Cumulative IncidenceHazard Ratio*SBPWomen Men120/80 1.0 1.0 120-129 1.5 1.3 130-139 2
18、.5 1.6H.R. adjusted for age, BMI, Cholesterol, Diabetes and smoking *P.001Framingham Study: Subjects Ages 35-90 yrs. 1.92.84.45.87.610.1Prevalence of high blood pressure in Adults by age and sex (NHANES: 1999-2004). Source: NCHS and NHLBI.Extent of awareness, treatment and control of high blood pres
19、sure by age (NHANES : 1999-2004.) Source: NCHS and NHLBI.Age-adjusted prevalence trends for high blood Age-adjusted prevalence trends for high blood pressure in Adults age 20 and older by pressure in Adults age 20 and older by race/ethnicity, sex and survey race/ethnicity, sex and survey (NHANES: 19
20、88-94 (NHANES: 1988-94 and 1999-2004).and 1999-2004). Source: NCHS and NHLBI. Source: NCHS and NHLBI. Extent of Awareness, Treatment and Control of High Blood Pressure by Race/Ethnicity (NHANES: 1999-2004).Source: NCHS and NHLBI.CK Friedberg on HypertensionDiseases of the Heart 1966 “Hypertension im
21、poses a load on the heart which for many years may be compensated by left ventricular hypertrophy”_CVD Risk Imposed by ECG-LVH Framingham Study 36-yr. Follow-upAge-adjustedAge-adjusted Risk Risk Excess Risk Excess Risk Rate per 1000Rate per 1000 RatioRatio per 1000per 1000Age Men Women Men Women Men
22、 WomenAge Men Women Men Women Men Women35-64 164 135 35-64 164 135 4.7* 7.4* 129 117 4.7* 7.4* 129 11765-94 234 235 2.8* 4.1* 51 17865-94 234 235 2.8* 4.1* 51 178Biennial Rate per 1000. CVD=CHD, stroke, Biennial Rate per 1000. CVD=CHD, stroke, peripheral vascular disease, heart failureperipheral vas
23、cular disease, heart failure*P0.001*P0.001 _Smoking Statement Issued in 1956 by American Heart Association “It is the belief of the committee that much greater knowledge is needed before any conclusions can be drawn concerning relationships between smoking and death rates from coronary heart disease
24、. The acquisition of such knowledge may well require the use of techniques and research methods that have not hitherto been applied to this problem.”Circulation 1960; vol. 23Circulation 1960; vol. 23_CHD Risk by Cigarette Smoking. Filter Vs. Non-filter. Framingham Study. Men 55 Yrs.Men 55 Yrs.14-yr.
25、 Rate/1000 11920621059112210Prevalence of current smoking for Adults age 18 and older by race/ethnicity and sex (NHIS:2004).Source: MMWR. 2004;54:1121-24. NH non-Hispanic.Prevalence of high school students in grades 9-12 Prevalence of high school students in grades 9-12 reporting current cigarette s
26、moking by race/ethnicity reporting current cigarette smoking by race/ethnicity and sex. and sex. (YRBS:2005). (YRBS:2005). Source: MMWR. 2006;55:SS-5. June 9, 2006. . NH non-Hispanic.Source: MMWR. 2006;55:SS-5. June 9, 2006. . NH non-Hispanic.Diseases of The HeartCharles K Friedberg MD, WB Saunders
27、Co. Philadelphia, 1949 “The proper control of diabetes is obviously desirable even though there is uncertainty as to whether coronary atherosclerosis is more frequent or severe in the uncontrolled diabetic” _Risk of Cardiovascular Events in Diabetics Framingham StudyFramingham Study Age-adjustedAge-
28、adjusted Biennial Rate Age-adjustedBiennial Rate Age-adjusted Per 1000Per 1000 Risk RatioRisk RatioCardiovascular EventCardiovascular Event Men WomenMen Women Men WomenMen WomenCoronary DiseaseCoronary Disease 39 2139 21 1.5* 2.2* 1.5* 2.2*StrokeStroke15 615 6 2.9* 2.6* 2.9* 2.6*Peripheral Artery Di
29、s. 18 18Peripheral Artery Dis. 18 18 3.4* 6.4* 3.4* 6.4*Cardiac FailureCardiac Failure 23 21 23 21 4.4* 7.8* 4.4* 7.8*All CVD EventsAll CVD Events 76 65 2.2* 3.7* 76 65 2.2* 3.7*Subjects 35-64 36-year Follow-up *P.001,*P.0001Subjects 35-64 36-year Follow-up *P.001,*P.0001_Age-adjusted prevalence of
30、physician-diagnosed diabetes in Adults age 18 and older by race/ethnicity and sex (NHANES: 1999-2004). Source: NCHS and NHLBI. NH non-Hispanic.Mortality rates in U.S. adults, age 30-75, with metabolic Mortality rates in U.S. adults, age 30-75, with metabolic syndrome (MetS), with and without diabete
31、s mellitus (DM) and syndrome (MetS), with and without diabetes mellitus (DM) and pre-existing CVD pre-existing CVD (NHANES II: 1976-80 Follow-up Study). * (NHANES II: 1976-80 Follow-up Study). * Source: Malik et al., Circulation. 2004;110:1245-50. Source: Malik et al., Circulation. 2004;110:1245-50.
32、 * Average of 13 years of follow-up. * Average of 13 years of follow-up. Note: Age and gender adjusted.Note: Age and gender adjusted.Skepticism About Importance of ObesityKeys A, Aravanis C, Blackburn H, et al. Ann Intern Med 1972; 77:15-27.Concluded that all the excess risk of coronary heart diseas
33、e in the obese derives from its atherogenic accompaniments, illogically leaving the impression that obesity is therefore unimportant.Mann GV. N Engl J Med 1974; 291:226-232.“The contribution of obesity to CHD is either small or non-existent. It cannot be expected that treating obesity is either logi
34、cal or a promising approach to the management of CHD”. Barrett-Connor EL. Ann Intern Med 1985; 103:1010-1019NIH consensus panel is equivocal about the role of obesity as a cause of CHD.Relation of Weight Change to Changes in Atherogenic Traits: The Framingham StudyFrantz Ashley, Jr. and William B Ka
35、nnelJ Chronic Dis 1974“Weight gain is accompanied by atherogenic alterations in blood lipids, blood pressure, uric acid and carbohydrate tolerance.”“It seems reasonable to expect that correction of overweight will improve the coronary risk problem.”“Avoidance of overweight would seem a desirable goa
36、l in the general population if the appalling annual toll from disease is to be substantially reduced.”32.41.81.20.60(1971)(1989)Q1Q2Q3Q4Q5OverallThinObeseRisk Factor Sum and Obesity(1971-74) and (1989-93)Risk Factor SumRisk variables include bottom quintile for HDL-C and top quintiles for cholestero
37、l, SBP, triglycerides and glucoseFramingham StudyRisk factors accumulate with weight gainNote: Obesity is defined as a BMI of 30.0 or higher.Age-adjusted prevalence of obesity in Adults ages Age-adjusted prevalence of obesity in Adults ages 20-74 by sex and survey 20-74 by sex and survey (NHES, 1960
38、-62; NHANES, 1971-74, 1976-80, (NHES, 1960-62; NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004)1988-94 and 2001-2004). Source: Health, United States, Source: Health, United States, 2006, unpublished data. NCHS2006, unpublished data. NCHS. .Trends in prevalence of overweight among U.S. Trends in prev
39、alence of overweight among U.S. children and adolescents by age and survey children and adolescents by age and survey (NHANES, 1971-74, 1976-80, 1988-94 and 2001-(NHANES, 1971-74, 1976-80, 1988-94 and 2001-2004).2004). Source: Health, United States, 2006, unpublished data. NCHS.Source: Health, Unite
40、d States, 2006, unpublished data. NCHS.Prevalence of overweight among students in grades 9-12 by race/ethnicity and sex (YRBS: 2005). Source: BMI 95Source: BMI 95thth percentile or higher. percentile or higher. MMWR. 2006 55: No. SS-5. NH non-Hispanic.MMWR. 2006 55: No. SS-5. NH non-Hispanic.Prevale
41、nce of leisure-time physical inactivity among adults age 18 and older by race/ethnicity, and sex. (BRFSS: 1994 and 2004). Source: MMWR, 2005;54:No. 39. NH non-Hispanic.Note: “Currently recommended levels” is defined as activity that Note: “Currently recommended levels” is defined as activity that in
42、creased their heart rate and made them breathe hard some of increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes/day on 5 or more of the the time for a total of at least 60 minutes/day on 5 or more of the 7 days preceding the survey. 7 days preced
43、ing the survey. Prevalence of students in grades 9-12 who met currently Prevalence of students in grades 9-12 who met currently recommended levels of physical activity during the past recommended levels of physical activity during the past 7 days by race/ethnicity and sex 7 days by race/ethnicity and sex (YRBS: 2005)(YRBS: 2005). . Source: MMWR. 2006;55:No. SS-5. NH non-Hispanic.Source: MMWR. 2006;55:No. SS-5. NH non-Hispanic.
