Past, Present and Future of Cardiovascular Epidemiology and Prevention in the U.S.A.

Abstract

Concern about rising coronary heart disease (CHD) death rates and awareness of international differences in CHD and stroke mortality led to early epidemiological studies including Framingham Heart, Seven Countries and NI-HON-SAN studies. Elevated blood cholesterol and blood pressure, cigarette smoking and diet were identified as risk factors, predominantly in men. Clinical trials demonstrated the feasibility and efficacy of lowering risk factors through pharmacologic and behavioral interventions. The continuing decline in CHD mortality began in the late 1960's and is attributable to healthier lifestyles and improved medical management. Current epidemiological studies include more women and diverse populations and expand potential risk factors and outcomes to include obesity, diabetes, hemostatic and psychosocial factors, physical inactivity and genes, as well as markers of pre-clinical atherosclerosis, ischemia, and cardiac dysfunction. CVD prevention encompasses national education programs, community interventions and high risk approaches. In the future new insights are expected on the interplay of genetic susceptibility and non-genetic risk and protective factors and on precipitants of clinical events. Advances in treatment and wider use of preventive measures should reduce or delay CVD especially among low socio-economic groups, the elderly and survivors of an event. National goals for lower rates of CHD, stroke and risk factors have been set for the year 2000. J Epidemiol, 1996 ; 6 : S203-S207.