Cardiovascular disease (CVD) mortality has declined more than 30% in the last thirty years. Almost two-thirds of this decline occurred between 1970 and 1980. Despite this decreased mortality, CVD is still the leading cause of death. It is also the disease category associated with the most rapidly rising health care costs. Secular trends in lifestyle, self-care, improved access to medical care, and improvements in diagnostic and curative medicine have all been implicated. An understanding of the mechanisms contributing to this decline is necessary in order to develop a scientific basis for palliative and preventive care. Previous work by the investigators which explored secular trends in CVD incidence and mortality has shown that there were significant differences in 13-year CVD mortality and in 10-year case-fatality rates among three similarly-aged birth-cohorts in the Framingham Heart Study population. This was not due to a decrease in CVD incidence, a change in case mix, or a decline in prevalence of CVD. The dramatic decline in CVD mortality has raised the issue of the quality of life among the survivors. The question is raised whether more people are surviving but with """"""""worsening health"""""""" in terms of increased incidence and prevalence of disease as well as increased levels of functional limitation. Through the proposed research, the question of the influence of secular trends on CVD mortality and subsequent morbidity can begin to be addressed. The logistic and multiple regression techniques discussed will enable the investigators to ascertain the effects of trends in risk factors, comorbidity, and medical care on CVD mortality as well as ascertain their contribution to subsequent morbidity and functional limitation among survivors.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL040423-02
Application #
3357618
Study Section
Epidemiology and Disease Control Subcommittee 3 (EDC)
Project Start
1988-04-01
Project End
1991-03-31
Budget Start
1989-04-01
Budget End
1990-03-31
Support Year
2
Fiscal Year
1989
Total Cost
Indirect Cost
Name
Boston University
Department
Type
Schools of Arts and Sciences
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Fleming, Diana J; Tucker, Katherine L; Jacques, Paul F et al. (2002) Dietary factors associated with the risk of high iron stores in the elderly Framingham Heart Study cohort. Am J Clin Nutr 76:1375-84
Fleming, D J; Jacques, P F; Massaro, J M et al. (2001) Aspirin intake and the use of serum ferritin as a measure of iron status. Am J Clin Nutr 74:219-26
Fleming, D J; Jacques, P F; Tucker, K L et al. (2001) Iron status of the free-living, elderly Framingham Heart Study cohort: an iron-replete population with a high prevalence of elevated iron stores. Am J Clin Nutr 73:638-46
Bostom, A G; Silbershatz, H; Rosenberg, I H et al. (1999) Nonfasting plasma total homocysteine levels and all-cause and cardiovascular disease mortality in elderly Framingham men and women. Arch Intern Med 159:1077-80
Bostom, A G; Rosenberg, I H; Silbershatz, H et al. (1999) Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: the Framingham Study. Ann Intern Med 131:352-5
Fleming, D J; Jacques, P F; Dallal, G E et al. (1998) Dietary determinants of iron stores in a free-living elderly population: The Framingham Heart Study. Am J Clin Nutr 67:722-33
Wolf, P A (1998) Prevention of stroke. Lancet 352 Suppl 3:SIII15-8
Jacques, P F; Felson, D T; Tucker, K L et al. (1997) Plasma 25-hydroxyvitamin D and its determinants in an elderly population sample. Am J Clin Nutr 66:929-36
Selhub, J; Jacques, P F; Bostom, A G et al. (1996) Relationship between plasma homocysteine, vitamin status and extracranial carotid-artery stenosis in the Framingham Study population. J Nutr 126:1258S-65S
Wolf, P A; Benjamin, E J; Belanger, A J et al. (1996) Secular trends in the prevalence of atrial fibrillation: The Framingham Study. Am Heart J 131:790-5

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