High Heart Attack Risk: Identify Important Risk Factors for Heart Disease Today

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In Spain the prevalence of smoking is very high, and although it has decreased slightly in men, it has increased in women in the last decade Figure 5. Figure 5. Trends in the prevalence of smoking in the population of Girona in the last 10 years.. Diabetes is associated with a 2- to 3-fold increase in the likelihood of developing CVD, 54 this increase being higher in women than in men 55 ; glucose intolerance is also associated with a 1. Moreover, diabetes is also associated with a higher probability of presenting with hypertrigliceridemia, low HDL-C, high blood pressure, and obesity, which usually precede the onset of diabetes.

Physical Inactivity. Since the first study of Morris et al published in , 63 a number of epidemiological studies have confirmed an association between physical inactivity and CHD. Obesity is a chronic metabolic disorder associated with numerous comorbidities such as CHD, 69 CVD, 70 type 2 diabetes, 62 hypertension, 71 certain cancers, and sleep apnea. Obesity is also an independent risk factor for all-cause mortality, 72,73 a relationship identified by Framingham investigators 40 years ago.

The prevention and control of overweight and obesity in adults and children has become a key element for the prevention of cardiovascular diseases. Novel Risk Factors. Nonetheless, research on non-traditional risk factors and genetic causes of heart disease is important to discovering new pathways related to atherosclerosis.


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Chronic diseases such as CVD are the result of complex interactions between genetic and environmental factors over extended periods of time. In this section we will analyze the ability of risk factors to predict future CVD events.. One of the contributions of Framingham investigators was to develop new multivariate statistical methods to analyze the development of complex disease.

Estimation of CHD and other cardiovascular events is a dynamic field and various functions have been proposed and developed by Framingham investigators. However, reasonable accuracy in predicting CHD has been demonstrated in various populations from the United States, Australia, and New Zealand, and although it overestimates the absolute risk in China and European populations, 89 after recalibration for differing prevalences of risk factors and underlying rates of CHD events, it can be applied in different populations 90 including the Spanish population. The accuracy of a risk function reflects on both the ability to distinguish individuals who will and will not develop the disease discrimination , and the close matching of predicted and observed probabilities calibration..

Discrimination is the ability of a prediction model to separate those who experience a CHD event from those who do not. It is usually quantified by calculating the c statistic, analogousto the area under a receiver operating characteristic ROC curve; this value is an estimate of the probabilitythat a model assigns a higher risk to those who develop CHDwithin a 5-year follow-up period than to those who do not.

Calibration measures how closely predicted probabilities of CHD agree with actual outcomes. Calibration is evaluated by using a measure that summarizes how closely the predicted and observed risks agree within each decile of predicted risk Hosmer-Lemeshow statistic. As mentioned above, when the risk function is used in populations with a probability of disease or a prevalence of risk factors that is very different from the population in which the risk function was developed, the function must be recalibrated to maintain its accuracy.

What are common symptoms of cardiovascular diseases?

The selection of risk factors to be included in a risk prediction equation is usually controversial, and involves the availability of methods to measure risk factors, the costs of those measurements, and general considerations of parsimony, and accuracy of the equation. Once the risk prediction equation is validated, however, the key question is how much the addition of a new risk factor improves prediction. The change in c -statistic, as a measure of the discrimination ability, provides one indication of that improvement..

Although various new risk factors have been shown to be associated with CHD they have failed to significantly improve the discriminatory capacity of the classical Framingham risk function, even with a magnitude of association measured as a odds ratio or hazard ratio greater than 3. Figure 6. Overlapping in the risk factor distribution between individuals with the disease and healthy individuals that explain the high proportion of false positive and negative individuals when using cardiovascular risk functions to predict cardiovascular events..

At the time when the first results of epidemiological studies were emerging, opinions on the need to detect and treat asymptomatic risk factors, such as hypertension or hypercholesterolemia differed. As Dr W. Kannel, a former chief investigator in the Framingham Heart Study, stated, "Cardiovascular events are coming to be regarded as a medical failure rather than the first indication of treatment.

Current guidelines provide advice on screening and identifying asymptomatic individuals at risk of developing CVD.

Gender matters: Heart disease risk in women - Harvard Health

The objectives of these guidelines are to reduce the incidence of first or recurrent clinical events due to coronary heart disease, ischemic stroke, and peripheral artery disease. The focus is on prevention of disability and early death. To thisend, the current guidelines address the role of lifestyle changes, the management of major cardiovascular risk factors and the use of different prophylactic drug therapies in the prevention of clinical CVD. The first step in this process is the calculation of individual cardiovascular risk according to risk factor exposure. On the other hand, we do not have to consider cardiovascular risk functions as diagnostic test because their sensitivity and specificity is low Figure 6.

Considering that cardiovascular diseases continue to be the leading cause of mortality in industrialized countries, more effort is required to reduce the burden of these diseases.


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In this context, lifestyle modifications based on avoiding smoking, taking regular physical exercise, and improving control of hypertension could be the most effective intervention at the population level. Home Articles in press Current Issue Archive. ISSN: Previous article Next article. Issue 3. Pages March Cardiovascular Risk Factors. Insights From Framingham Heart Study. Factores de riesgo cardiovascular.

Perspectivas derivadas del Framingham Heart Study. Download PDF. This item has received. Article information.

Show more Show less. Epidemiology involves the study of disease frequency and its determinants within the population. Cardiovascular epidemiology began in the s as a result of changes observed in the causes of death.

Risk Factors for Sudden Cardiac Death in Post-Menopausal Women with Coronary Artery Disease

In the s, several epidemiological studies were set in motion with the aim of clarifying the cause of cardiovascular disease. Four years after the Framingham Heart Study started, researchers had identified high cholesterol and high blood pressure levels as important factors in the development of cardiovascular disease. In subsequent years, the Framingham study and other epidemiological studies have helped to identify other risk factors, which are now considered classical risk factors. Today, a risk factor is defined as a measurable characteristic that is causally associated with increased disease frequency and that is a significant independent predictor of an increased risk of presenting with the disease.

This wide-ranging overview describes some of the most important insights into the causes of cardiovascular disease to have come from the Framingham Heart Study. The emphasis is on the identification of risk factors, and the assessment of their predictive ability and their implications for disease prevention.. Cardiovascular disease. Palabras clave:.

Enfermedad cardiovascular. Around the middle of the last century cardiovascular disease mortality began to increase rapidly, but very little was known about its origins and causes. The town of Framingham, located 32 Km west of Boston, Massachusetts, was selected because it had been the site of a successful community-based tuberculosis study undertaken in , and because of its proximity to Boston's major medical centers, the presence of several large employers and the support of a well-informed and highly cooperative medical and civil community.

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Heart Disease Risk Factors

New York: Oxford University Press; Twentieth-century changes in the treatment of septic infections.. N Engl J Med, , pp. Assessing the contributions of John Snow to epidemiology: years after removal of the broad street pump handle.. Epidemiology, 15 , pp. Med Klin, 28 , pp. Atherosclerosis: a problem in newer Public Health.. J Mt Sinai Hosp, 20 , pp. A prospective study of cardiovascular disease in Albany: report of three years' experience: ischemic heart disease.. Am J Public Health, 47 , pp.

Measuring the risk of coronary heart disease in adult population groups, IV: clinical status of a population group in Los Angeles under observation for two-three years.. Coronary heart disease in the Framingham Study.. Coronary heart disease among Minnesota business and professional men followed 15 years.. Circulation, 28 , pp.

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Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to the incidence of major coronary events: final report of the pooling Project.. J Chronic Dis, 31 , pp. Epidemiological approaches to heart disease: the Framingham Study.. Am J Public Health, 41 , pp. Am J Epidemiol, , pp. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded?

JAMA, , pp. The Seven Countries Study: 2, deaths in 15 years.. Prev Med, 13 , pp. Cholesterol and mortality: 30 years of follow-up from the Framingham Study.. Atherosclerosis and related factors in immigrants to Israel.. Circulation, 22 , pp. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: demographic, physical, dietary and biochemical characteristics..


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