Prospective Assessment of Coronary Heart Disease Risk Factors: The NHANES I Epidemiologic Follow-up Study (NHEFS) 16-Year Follow-up

Abstract

Objective: Our specific aim in the 16 year prospective NHANES I epidemiologic follow-up study (NHEFS) was to assess the important roles of modifiable dietary and behavioral factors in causation and prevention of deaths and hospitalizations for coronary heart disease (CHD).Methods: Using NHEFS 16 year follow-up data (1971 to 1987), we studied 5811 subjects, 1958 with and 3853 without CHD events, using logistic regression.Results: In age groups 40 to 49, 50 to 59, 60 to 69, and 70 to 74 years (at study entry in 1971–4), the numbers of men and women were respectively 597 and 1019, 570 and 619, 932 and 1042, and 486 and 546. The following factors were independently positively associated (p<.05) with CHD: age, serum cholesterol, body mass index, cigarette use, and region (Midwest, Northeast). The following factors were independently negatively associated (p<.05) with CHD: gender (female), race (black), fish intake, alcohol, high school education, moderate exercise, and moderate and heavy habitual physical activity. Subjects with serum cholesterol >249 mg/dl benefitted less (p=.04) from fish intake than those with 209 to 249 or <209, and benefitted less (p=.03) from alcohol intake (CHD incidence [%]):Cholesterol<209209–249>249<209209–249>249FishNone39%40%45%AlcoholNone38%39%41%<1/week33%32%41%<1/week27%28%38%≥1/week26%30%38%1–6/week23%26%37%≥1/day30%29%42%Conclusions: These associations emphasize the important role of modifiable dietary and behavioral factors in the causation and prevention of CHD.