Cardiovascular disease (CVD) mortality declined more than 30% in the United States between 1950 and 1980. Secular trends in life style, in access to medical care, and in diagnostic and curative medicine have all been implicated in this decline. Concomitantly, the issue of """"""""worsening health"""""""" among these """"""""new survivors"""""""" has arisen. The long-term objectives of this research proposal are: (1) to delineate the mechanisms behind the decline in CVD mortality and (2) to investigate trends in health and functional status related to improvements in CVD mortality status related to improvements in CVD survival. This is a resubmission of an application for a competitive renewal of an ancillary study of the Framingham Heart Study to examine the mechanism behind the decline in CVD mortality and to investigate trends in health and functional status related to improvements in CVD survival. In the past two and one-half years, we have developed and refined new methods for conducting modified cross-sectional analyses using the Framingham Heart Study data. We have shown that cardiovascular disease mortality fell -66% for men and -59% for women between 1950 and 1979. However, despite significant improvements in CVD risk factors, incidence declined only -24% for men and -14% for women during this period. Thus, we find that more than two-thirds of the decline in CVD mortality could be attributed to gains in case fatality rates. Life table, survival regression (Cox proportional hazard and Weibull models), loglinear, logistic regression, and time dependent analytic techniques will be used. Through the proposed analyses, we will be able to elucidate the short and long-term factors behind the decline in CVD mortality and evaluate the contribution of secular trends in risk factors and medical care to that decline. Further, we will be able to assess the effect of trends in morbidity and functional limitation on the health status of survivors.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL040423-06
Application #
2219603
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Project Start
1988-04-01
Project End
1996-03-31
Budget Start
1994-04-01
Budget End
1996-03-31
Support Year
6
Fiscal Year
1994
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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