To the Framingham Data, Turn, Turn, Turn

Abstract

Beginning in the mid to late 1960s and continuing to the present, declines in the annual death rates attributed to coronary heart disease (CHD) have been observed in American men and women, reversing previously observed trends of steadily increasing mortality from CHD.1 Despite these encouraging trends, CHD continues to be a leading cause of morbidity and mortality in American men and women. It has been estimated that almost 1 in every 2 middle-aged American men and 1 in every 3 American woman will develop CHD during their lifetime.2 Article p 1203 Epidemiologists have provided extensive insights into the predictive and relative importance of a variety of predisposing factors for CHD. This has been accomplished through the conduct of a number of landmark longitudinal studies including the community-based Framingham Heart Study, the migrant Ni-Hon-San Study, and the international Seven Countries Study. Elevated blood cholesterol levels, cigarette smoking, increased levels of blood pressure, diabetes mellitus, the metabolic syndrome, and high fat diets have been consistently linked to the occurrence of CHD. More recent investigations have suggested that there may be other factors involved in the pathogenesis of CHD including cell inflammation, disturbances in clotting and hemostasis, plaque vulnerability, and alterations in autonomic tone of the coronary vasculature. Concomitant with an enhanced understanding of the risk factors involved in the development of coronary atherosclerosis and its different clinical manifestations, and greater appreciation of the multidecade-long natural history of CHD, remarkable advances have been made in the primary and secondary prevention of acute coronary disease, especially during the past 2 decades. In the 1960s, prolonged bed rest and treating complications as they occurred were the mainstay approaches used for the treatment of patients with acute myocardial infarction (AMI). In the 1980s, however, coincident with new insights into the underlying pathophysiology of AMI …