sociology (1).pptx

8/18/2019 sociology (1).pptx

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Introduction

Cardiovascular disease is the most common cause of

mortality in high-income and developed countries. In

2015, one in three deaths is due to cardiovascular

disease.

On Sept 2, 1!" - #" years ago, $ramingham %eart

Study &as esta'lished. In this presentation &e descri'e

the events leading to the foundation of the study, and

revie& some important contri'utions that the study hasmade to achieve understanding of cardiovascular

disease and its ris( factors.


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Origins of the $ramingham %eart

Study

)y the 1!0s, cardiovascular disease &as the main

cause of death for *mericans.

$ran(lin + oosevelts death due to cardiovasculardisease acted as a catalyst for researching the etiology

of the disease.


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ocation of the study

/he long-term, study &as performed on residents of the to&nof $ramingham, assachusetts.

/he state &as thought ideal 'ecause of the enthusiastic

response of physicians in the area, and $ramingham &as

selected ahead of neigh'oring to&ns 'ecause of its

geographical proimity to the many cardiologists at %arvard

edical School.

oreover, residents of the developing to&n had already

participated $ramingham /u'erculosis +emonstration Study

t&o decades earlier. /herefore it &asthought to 'e representative of S*

in the 1!0s


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3arly days of the Study

On Septem'er 2, 1!", the $ramingham %eart Study

started 'y eamining its o&n staff mem'ers.

On Octo'er 11, 1!", the study officially eamined its first

$ramingham participant. /he 'asic &or( had thus 'een laid

for the longitudinal follo&-up of this group, to identify

individual factors that could 'e related to the futuredevelopment of cardiovascular disease.

Investigators of the study initially decided on an

o'servational study to understand heart disease, rather

than focus on prevention of heart disease.


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*fter that, investigators reali4ed that measurement of the

prevalence of diseases needed random sampling, so they

changed the method from see(ing for volunteers to active

recruitment of a random sample of adults in the to&n, thatall family mem'ers aged 06#0 years &as to 'e recruited.


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/he first ma7or findings from the study &ere reported in

158, almost a decade after the first participant &as

eamined. +efining hypertension as 'lood pressure of

1#095 mm %g or higher, the investigators noted a nearly

four-times increase in incidence of coronary heart disease

per 1000 people for study participants &ith hypertension.


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$ight $or Survival

$ramingham investigators toured the

country to raise private funds. +onors

included a large num'er of life insurance

corporations that recogni4ed theactuarial 'enefits of the study. /he list

also included some surprising

contri'utors, such as the /o'accoesearch Institute and the Oscar ayer

Company, a meat manufacturer.


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/he study 'egan to recruit the children of the

original $ramingham participants into a ne&Off spring cohort, the purpose of this &as to

provide insights into familial clustering of

disease. )ecause the study also needed to include

'iologically unrelated individuals, spouses of

off spring participants &ere invited into the

study, ma(ing up nearly a third of the study

sample.


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3pidemiological activism

In the 180s, physician reference 'oo(s suchas %arrisons :rinciples of Internal edicine

reiterated that diastolic pressure &as a 'etter

measure of 'lood pressure than &as systolic

pressure; conse


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$ramingham investigators analy4ed and

reported increased ris( of coronary heart-disease mor'idity &ith increased 'aseline

'lood pressure. Systolic pressure had a

stronger association &ith coronary-heart-disease events than did diastolic pressure.

$ramingham studies sho&ed that high

systolic 'lood pressure &as a predictor of

cere'rovascular accidents and heart failure,and that diastolic pressure &as not a 'etter

predictor of such events.


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/he $ramingham %eart Study and other

epidemiological cohorts contri'uted to a shift in

focus in the second half of the 20th century, from

treatment of those having cardiovascular disease to

the prevention of disease in those at ris(. =hich

&as a ma7or advancement 'ac( then. Studies from

this period helped to elucidate cardiovascular ris(factors, such as hypertension, hyperlipidemia, and

dia'etes mellitus.


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/he $ramingham investigators proposed

multivaria'le logistic models &ith seven ris(

factors> age, total cholesterol, &eight,electrocardiogram a'normalities, hemoglo'in,

num'er of cigarettes smo(ed, and systolic

'lood pressure. en in the top decile had a 0-

times higher incidence of coronary heartdisease than did men in the 'ottom decile, and

&omen in the top decile had a 80-times higher

incidence than did &omen in the 'ottom decile.Su'se


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oosevelts failing health from heart failure underscores

the poor understanding of the clinical syndrome at the

time the $ramingham %eart Study &as initiated. +ue to

a'sence of consistent results, and standardi4ed criteria it&as al&ays difficult to carry out research and dra&

assumptions.

In 181, ne&ly descri'ed criteria sho&ed that

hypertension &as in fact the leading ris( factor for heartfailure.

/he original 181 pu'lication sho&ed the poor prognosis

for heart failure> only t&o in five men &ere alive 5 years

after diagnosis of heart failure, and only one in fivesurvived to 10 years. )y the 10s, the &idespread use

of mortality-altering drugs such as ? 'loc(ers and

angiotensin-converting-en4yme inhi'itors had altered this

prognosis decreasing mortality.


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ecent guidelines have a nota'le emphasis on the

detection of asymptomatic ventricular dysfunction

@stage-) heart failureA as part of efforts to

understand and prevent overt heart failure. In the first half of the 20th century, findings of

autopsy and hospital-'ased studies sho&ed an

association 'et&een dia'etes mellitus and

cardiovascular disease. )y the early 20th century, cholesterol had 'een

lin(ed to cardiovascular disease through animal and

autopsy studies.


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In 188, an inverse association 'et&een %+

concentrations and incidence of coronary heart

disease &as reported, 'y contrast &ith the positiveassociation 'et&een + concentrations and

incidence of coronary heart disease.

/he population attri'uta'le ris( for heart failure

due to o'esity &as 1!B in &omen, and 11B inmen, higher than that of dia'etes mellitus, valvular

heart disease, or left-ventricular hypertrophy.

$ramingham investigators sho&ed that the ris( ofstro(e from hypertension &as even greater than

that conferred 'y coronary heart disease.


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/o&ards the end of the 20th century, $ramingham

investigators identified a need to epand

(no&ledge a'out genetic and environmental ris(

factors for cardiovascular disease.


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Conclusion

early seven decades have passed since oosevelts

death in 1!5 after a long illness that started &ith

uncontrolled hypertension and progressed to heart failure

and stro(e. Dears later, reflecting on the :residents

premature death, his cardiologist &rote> EI have often&ondered &hat turn the su'se


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/%*G DO

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sociology (1).pptx