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1、Lifetime Risk of Coronary Heart Disease in the Framingham Study,Men Women,At age 40 years:48.6%31.7%At age 70 years:34.9%24.2%Lloyd-Jones et al.Lancet 1999;353:89-92,_,_,_,First Coronary Events:Framingham Study,Percent as Specified EventMyocardialAngina SuddenInfarctionPectoris DeathAgeMen Women Men
2、 Women Men Women35-64 43%28%41%59%9%4%65-84 55%44%28%41%11%7.4%Framingham Study 44 year follow-up.,_,_,_,Estimated 10-Year CHD Risk in 55-Year-Old Adults According to Levels of Various Risk Factors Framingham Heart Study,A B C DBlood Pressure(mm Hg)120/80140/90140/90140/90Total Cholesterol(mg/dL)200
3、 240 240 240HDL Cholesterol(mg/dL)50 50 40 40Diabetes No No Yes YesCigarettes No No No Yes,Estimated 10-Year Stroke Risk in 55-Year-Old Adults According to Levels of Various Risk Factors Framingham Heart Study,ABCDEFSystolic BP*95-105130-148130-148130-148130-148130-148DiabetesNoNoYesYesYesYesCigaret
4、tesNoNoNoYesYesYesPrior Atrial Fib.NoNoNoNoYes YesPrior CVDNoNoNoNoNoYes,Source:Stroke 1991;22:312-318.,*BP in millimeters of mercury(mmHg),ABCDEFSystolic BP*95-105130-148130-148130-148130-148130-148DiabetesNoNoYesYesYesYesCigarettesNoNoNoYesYesYesPrior Atrial Fib.NoNoNoNoYes YesPrior CVDNoNoNoNoNoY
5、es,Estimated 10-year stroke risk in 55-year-old adults according to levels of various risk factors(FHS).Source:Wolf et al.,Stroke.1991;22:312-318.,*BP in millimeters of mercury(mmHg),Offspring CVD Risk by Parental CVD Status:Framingham Study,Risk Ratio,2.5,2,1.5,1,0.5,0,Men,Women,1.0,1.7,2.2,1.0,1.7
6、,1.7,Adjusted for:age,total/HDL Chol.ratio,SBP,smoking,diabetes,BMI,Parental CVD 55 men,65 Women,Multivariable Risk,Risk imposed by a strong family history of heart attacks varies widely depending on the burden of modifiable risk factors,9,Doubts about cholesterol as late as 1989,Risk of Coronary He
7、art Diseaseby Serum Cholesterol,30-Year Follow-up,The Framingham Study,*Trends Significant at P.001.+P.07.,Age-Adjusted Annual Rate per 1000,Q=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 Cho
8、lesterol and CVD Mortality,6-Year CVD Death Rate Per 1000,0,5,10,15,20,25,30,Q1(182),Q2(182-202),Q3(203-220),Q4(221-244),Q5(244),35-39 years,40-44 years,45-49 years,50-54 years,55-57 years,Serum Cholesterol Quintile(mg/dL),Untreated Patients,Lifetime Risk of CHD Increases with Serum Cholesterol,Fram
9、ingham Study:Subjects age 40 yearsDM Lloyd-Jones et al Arch Intern Med 2003;1966-1972,34,44,57,19,29,33,Cholesterol,_,_,Age-adjusted prevalence 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.,Ag
10、e-adjusted prevalence of Adults age 20 and older with HDL cholesterol 40 mg/dL,by race/ethnicity and sex(NHANES:2003-2004).Source:NCHS and NHLBI.NH non-Hispanic.,Trends in mean total serum cholesterol among adults age 20 and older,by race/ethnicity,sex and survey(NHANES:1988-94,1999-02 and 2003-04).
11、Source:NCHS and NHLBI.NH non-Hispanic.,Trends in mean total blood cholesterol among adolescents ages 12-17 by race,sex,and survey(NHES:1966-70;NHANES:1971-74 and 1988-94).Source:NCHS and NHLBI.,CK Friedberg on Hypertension:Diseases of the Heart 1996,“There is a lack of correlation in most cases betw
12、een the severity and duration of hypertension and development of cardiac complications.”,_,_,Relation of Non-Hypertensive Blood Pressure to Cardiovascular DiseaseVasan R,et al.N Engl J Med 2001;345:1291-1297,10-year Age-Adjusted Cumulative Incidence,Hazard Ratio*SBPWomenMen120/80 1.0 1.0 120-129 1.5
13、 1.3 130-139 2.5 1.6H.R.adjusted for age,BMI,Cholesterol,Diabetes and smoking*P.001,Framingham Study:Subjects Ages 35-90 yrs.,1.9,2.8,4.4,5.8,7.6,10.1,Prevalence 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
14、 blood pressure by age(NHANES:1999-2004.)Source:NCHS and NHLBI.,Age-adjusted prevalence trends for high blood pressure in Adults age 20 and older by race/ethnicity,sex and survey(NHANES:1988-94 and 1999-2004).Source:NCHS and NHLBI.,Extent of Awareness,Treatment and Control of High Blood Pressure by
15、Race/Ethnicity(NHANES:1999-2004).Source:NCHS and NHLBI.,CK Friedberg on HypertensionDiseases of the Heart 1966,“Hypertension imposes 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-up,Age-adjuste
16、d Risk Excess Risk Rate per 1000 Ratio per 1000Age Men Women Men Women Men Women35-64 164 135 4.7*7.4*129 11765-94 234 235 2.8*4.1*51 178Biennial Rate per 1000.CVD=CHD,stroke,peripheral vascular disease,heart failure*P0.001,_,_,_,Smoking Statement Issued in 1956 by American Heart Association,“It is
17、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.The acquisition of such knowledge may well require the use of techniques and research methods that have not hithe
18、rto been applied to this problem.”Circulation 1960;vol.23,_,_,_,CHD Risk by Cigarette Smoking.Filter Vs.Non-filter.Framingham Study.Men 55 Yrs.,14-yr.Rate/1000,119,206,210,59,112,210,Prevalence of current smoking for Adults age 18 and older by race/ethnicity and sex(NHIS:2004).Source:MMWR.2004;54:11
19、21-24.NH non-Hispanic.,Prevalence of high school students in grades 9-12 reporting current cigarette smoking by race/ethnicity and sex.(YRBS:2005).Source:MMWR.2006;55:SS-5.June 9,2006.NH non-Hispanic.,Diseases of The HeartCharles K Friedberg MD,WB Saunders Co.Philadelphia,1949,“The proper control of
20、 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 Study,Age-adjusted Biennial Rate Age-adjusted Per 1000 Risk RatioCardiovascular
21、Event Men Women Men WomenCoronary Disease 39 21 1.5*2.2*Stroke15 6 2.9*2.6*Peripheral Artery Dis.18 18 3.4*6.4*Cardiac Failure 23 21 4.4*7.8*All CVD Events 76 65 2.2*3.7*Subjects 35-64 36-year Follow-up*P.001,*P.0001,_,_,Age-adjusted prevalence of physician-diagnosed diabetes in Adults age 18 and ol
22、der 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 syndrome(MetS),with and without diabetes mellitus(DM)and pre-existing CVD(NHANES II:1976-80 Follow-up Study).*Source:Malik et al.,Circulation.2004;110:1245-50
23、.*Average of 13 years of follow-up.Note:Age and gender adjusted.,Skepticism About Importance of Obesity,Keys A,Aravanis C,Blackburn H,et al.Ann Intern Med 1972;77:15-27.Concluded that all the excess risk of coronary heart disease in the obese derives from its atherogenic accompaniments,illogically l
24、eaving 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 logical or a promising approach to the management of CHD”.Barrett-Connor EL.Ann
25、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 Study,Frantz Ashley,Jr.and William B KannelJ Chronic Dis 1974“Weight gain is accompanied by atherogenic alterations in
26、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 goal in the general population if the appalling annual toll from disease is to be sub
27、stantially reduced.”,3,2.4,1.8,1.2,0.6,0,Q1Q2Q3Q4Q5Overall,Thin,Obese,Risk Factor Sum and Obesity,(1971-74)and(1989-93),Risk Factor Sum,Risk variables include bottom quintile for HDL-C and top quintiles for cholesterol,SBP,triglycerides and glucose,Framingham Study,Risk factors accumulate with weigh
28、t gain,Note:Obesity is defined as a BMI of 30.0 or higher.,Age-adjusted prevalence of obesity in Adults ages 20-74 by sex and survey(NHES,1960-62;NHANES,1971-74,1976-80,1988-94 and 2001-2004).Source:Health,United States,2006,unpublished data.NCHS.,Trends in prevalence of overweight among U.S.childre
29、n and adolescents by age and survey(NHANES,1971-74,1976-80,1988-94 and 2001-2004).Source:Health,United States,2006,unpublished data.NCHS.,Prevalence of overweight among students in grades 9-12 by race/ethnicity and sex(YRBS:2005).Source:BMI 95th percentile or higher.MMWR.2006 55:No.SS-5.NH non-Hispa
30、nic.,Prevalence 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 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 7 days preceding the survey.,Prevalence of students in grades 9-12 who met currently recommended levels of physical activity during the past 7 days by race/ethnicity and sex(YRBS:2005).Source:MMWR.2006;55:No.SS-5.NH non-Hispanic.,
