Indicator Of Coronary Heart Disease Research Articles

Social class and coronary heart disease: A sociological assessment of the medical literature

THE PURPOSE of this paper is to review the recent medical literature on social class and coronary heart disease.? Specifically, the aims are (1) to summarize the basic findings of these studies; (2) to examine the indicators of social class that have been employed; (3) to consider the importance of the social context from which the indicators of social class were drawn; and (4) to assess the implications and the value of the various indicators of social class that were used. This paper does not consider the significance of the selection of specific indicators of the dependent variable, coronary heart disease. Nevertheless, it is worth noting that the criteria employed certainly could influence the relationship between the independent and dependent variables. In essence, one finds that two classes of data have been employed as indicators of coronary heart disease. The first type is based on physical examinations performed on living persons. The second type is based on a physician’s statement on a death certificate that death was due to coronary heart disease. Eight of the sixteen articles reviewed employ death certificate data at some point; the other eight do not. This paper does not undertake a systematic evaluation of the over-all methodology of each of the studies. The problem of methodology shades off into the previous one (i.e. specifying the dependent variable). For instance, the study at Du Pont by PELL and D’ALZONO considers only first events of coronary heart disease in order to eliminate the possible bias introduced by a prior coronary occurrence. [l] However, none of the studies using death certificates employ such refinements. Oftheeight studies which conducted physical examinations, only the Du Pont, Framingham [2] and Chicago utility [3] studies explicitly state they focus on first events. Every study reviewed found some relationship between class and heart disease, although the strength of the relationship varies markedly. In fact, one paper, by STAMLER and his associates, upon examining their own and others’ data, concludes that

Cholesterol-phospholipid ratio in the prediction of coronary heart disease. The Framingham study.

THE role of lipids as predictors of coronary heart disease has become of considerable interest during the past two decades. Many individual lipids, such as the serum cholesterol, phospholipid and various beta-lipoprotein fractions, have been extensively evaluated as indicators of coronary heart disease. Attempts have also been made to combine certain of these lipid values in the hope of producing an index that would be a more sensitive predictor of the potential for developing coronary heart disease than the individual lipids. Included among these proposed lipid indexes are the ratio of cholesterol to phospholipid and that of the uric acid . . .

Dietary fat, serum cholesterol levels and incidence of atherosclerosis in Delhi.

Very little information is available about the incidence of coronary heart disease in India, or of factors considered responsible for it. In a previous paper, the incidence of atherosclerosis as judged by electrocardiogram, the fat intake, and serum cholesterol levels in 2 low-income groups (industrial and rural) in Delhi were investigated. These data in high-income groups in Delhi have now been studied and the results compared. There were considerable differences in the findings in the 2 groups.