The Stanford Five-City Multifactor Risk Reduction Project is a long-term field study of the feasibility and effectiveness of community health education directed at lowering cardiovascular disease (CVD) risk, morbidity, and mortality. The Project began in 1978 and six years of education were completed in 1986. Risk factor change is measured by two series of representative population sample surveys, one a series of surveys on independent samples and the other a series of surveys on a cohort sample. Both series of surveys were completed in 1990. Morbidity and mortality are measured by a system of community surveillance of hospital records and death certificates, which is continuing. Current funding ends in June 1992. The purpose of the proposed competitive continuation is to 1) extend morbidity and mortality surveillance by three years (to June 1994 for events through December 1992); 2) to extend analysis and publication of FCP results and methods; and 3) to provide a small amount of incremental support to enable use of frozen plasma samples from earlier FCP population surveys to conduct a nested case-control study of the association of HDL subfractions and apolipoproteins with fatal and non-fatal cardiovascular disease. Extension of surveillance data collection is needed to insure the detection of any impact on morbidity and mortality of the significant risk factor changes that occurred in the treatment cities, compared to control cities, by 1986. Many potential analyses will not be possible within the current funding levels and duration, particularly those involving components of the intervention program, where the data sets are quite raw, and process evaluation. The nested case-control study will involve matching the survey and surveillance data sets to identify persons with documented events who participated in one of the five population surveys, identifying and contacting potential controls to be certain that they are free of CVD, and analysis of plasma samples frozen at -80 degrees centigrade for apolipoproteins A-I and B and HDL2,3 subfractions. This will allow multifactor assessment of the association between those factors and CVD in persons for whom many other variables are known.
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