Eggs, serum cholesterol, and coronary heart disease.

The Framingham Study has investigated the effect of host and environmental factors on the development of coronary heart disease since 1949. Serum cholesterol level was determined to the one of the risk factors for coronary heart disease. The nutrient intake, in a subsample of the study population, was determined in 1957. A review of this material has permitted an estimate of egg consumption on each of 912 subjects. The serum cholesterol distribution curves of the subjects according to tertile of egg intake were almost identical, and no relationship between egg intake and coronary heart disease incidence was found. It is concluded that within the range of egg intake of this population differences in egg consumption were unrelated to blood cholesterol level or to coronary heart disease incidence.

Lipoproteins, cardiovascular disease, and death. The Framingham study.

Based on six years of follow-up evaluations of the Framingham, Mass, men and women aged 49 to 82 years, it was found that a low-density lipoprotein (LDL) cholesterol concentration was associated with a low incidence of coronary heart disease (CHD) risk but with a statistically significant excess of stroke incidence in women and of deaths from non-CHD causes in both sexes. There was no suggestion that an elevated HDL cholesterol level was associated with an excess incidence of any of the cardiovascular end points considered or of death. An inverse relation of high-density lipoprotein (HDL) cholesterol level with CHD and its major consequences, CHD death and congestive heart failure, was observed. Triglyceride determinations seem to add little information respecting cardiovascular risk to that elicited from HDL and LDL cholesterol and other known cardiovascular risk factors. While the relation of HDL and LDL cholesterol with CHD is paralleled by findings from a variety of sources, the inverse relation of LDL cholesterol with stroke in women and with death from non-CHD causes requires additional confirmation and exploration.

The filter cigarette and coronary heart disease: the Framingham study.

Long-term follow-up of the Framingham cohort for coronary heart disease (CHD) end-points has made it possible to test the hypothesis that those who smoke filter cigarettes are less likely to get clinical manifestations of CHD than those who smoke non-filter cigarettes. Men were classified at the 7th biennial examination (1963--64) according to whether they smoked filter or non-filter cigarettes. 58% of the cigarette-smoking men under age 55 at this examination smoked filter cigarettes. These men had slightly lower prior smoking exposure than smokers of non-filter cigarettes. Despite what seemed to be a favourable cigarette-smoking history, the filter-cigarette smokers did not have lower CHD incidence rates than non-filter smokers. This finding was unchanged even after multivariate logistic regression analysis to adjust for the slight differences in age, systolic blood pressure, and serum cholesterol between the two groups.

Systolic blood pressure, arterial rigidity, and risk of stroke. The Framingham study.

Based on prospective data from the Framingham study relating systolic pressure, diastolic pressure, age, and pulse-wave configuration to future stroke incidence, it would appear that isolated systolic hypertension predisposes to stroke independent of arterial rigidity. The prevalence of isolated systolic hypertension increased with age and with the degree of blunting of the dicrotic notch in the pulse wave. Subjects with isolated systolic hypertension experienced two to four times as many strokes as did normotensive persons. While diastolic pressure is related to stroke incidence, in the subject with systolic hypertension, the diastolic component adds little to risk assessment and in men, in this subgroup, appears unrelated to stroke incidence.

Cancer incidence by levels of cholesterol.

In 5,209 subjects studied for 24 years in Framingham, Mass, 691 cases of cancer were documented, with histological confirmation for 94%. Predetermined personal characteristics were tested for associations with subsequent occurrence of cancer at specific sites using multiple logistic regression. Significant associations of various cancer sites with cigarette smoking, alcohol use, education, height, weight, and parity agreed with other studies. Serum cholesterol level was inversely associated with incidence of colon cancer and with other sites only in men; these inverse associations were statistically significant after adjustment for age, alcohol consumption, cigarette smoking, education, systolic blood pressure, and relative weight. Associations may reflect effects of competing lethal diseases, underlying pathophysiological mechanisms that promote or inhibit development of cancer in men, biologic or social response to early and undiagnosed states of cancer.

Perspectives on systolic hypertension. The Framingham study.

Diastolic hypertension has been widely and justifiably accepted as a cause of cardiovascular mortality. However, it has also been accepted that the cardiovascular sequelae of hypertension derive chiefly from the diastolic component. Because systolic and diastolic pressure are usually highly correlated it is not easy to dissociate the effects of each. Statistical analysis suggests that systolic pressure is actually the more potent contributor to cardiovascular sequelae. Even isolated systolic pressure elevation is associated witn an excess cardiovascular mortality. At low diastolic pressures (i.e., less than 95 mm Hg), risk rises with the level of systolic pressure. Also, isolated systolic hypertension is most ominous in the elderly, in whom it is highly prevalent. Isolated systolic hypertension was related to the occurrence of "direct" complications as well as to atherosclerotic sequelae. It was also associated with excess mortality, taking into account rigid vessels as judged from pulse-wave recordings. Trials to determine whether the treatment of isolated systolic hypertension is efficacious for avoiding its demonstrated excess cardiovascular morbidity and mortality are urgently needed.

The Framingham Eye Study monograph: An ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975.

Ophthalmologic examinations for cataract, glaucoma, diabetic retinopathy, macular degeneration and visual acuity were performed on 2631 of the 3977 members of the Framingham (Massachusetts) Heart Study population still living in 1973-1975. The subjects ranged in age from 52 to 85 years. This monograph presents the detailed protocols and record forms for screening and diagnostic examinations, definitions of the specific abnormalities and characteristics used to screen for each disease, criteria for suspicion and diagnosis of diseases, detailed tables of the basic data from the study, evaluation of quality of the data, and discussion of selected findings. The tables provide data on the number and proportion of persons and of eyes with each type of abnormality and each disease, by age and sex. Where appropriate, the data are further classified by location of abnormality, severity, bilaterality and associated visual acuity limitation. The study was sponsored by the National Eye Institute.

Epidemiologic profile of long-term stroke disability: the Framingham study.

One hundred forty-eight long-term stroke survivors and 148 control persons matched for age and sex, from the Framingham Study cohort, were examined for residual functional disability. Prevalence rates for 9 specific types of functional deficit ranged from 15% for institutionalization, to 63% for decreased vocational function in the group of stroke survivors. The comparable rates in the control group were significantly lower. Cardiovascular comorbidity was greater in stroke survivors than in controls. Removal of its apparent effects on function decreased the magnitude, but not the overall pattern, of documented disability in both groups. The most severe disabilities, institutionalization, dependence in mobility, and dependence in self-care, were the least prevalent. The more frequently documented types of functional deficit were those in which psychosocial and environmental factors are significant determinants.

Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study.

Chronic atrial fibrillation (AF) as a precursor of stroke was assessed over 24 years of follow-up of the general population sample at Framingham, Massachusetts. Persons with chronic established AF, with or without rheumatic heart disease (RHD), are at greatly increased risk of stroke, and the stroke is probably due to embolism. Chronic AF in the absence of RHD is associated with more than a fivefold increase in stroke indicence, while AF with RHD has a 17-fold increase. Stroke occurrence increased as duration of AF increased, with no evidence of a particularly vulnerable period. Chronic idiopathic AF is an important precursor of cerebral embolism. Controlled trials of anticoagulants or antiarrhythmic agents in persons with chronic AF may demonstrate if strokes can be prevented in this highly susceptible group.

Prevalence of senile cataract, diabetic retinopathy, senile macular degeneration, and open-angle glaucoma in the Framingham eye study.

Of the Framingham, Massachusetts Heart Study population, 2,675 individuals underwent an ophthalmologic evaluation that stressed detection of senile cataract, diabetic retinopathy, open-angle glaucoma, and senile macular degeneration. Those examined were 52 to 85 years old at the time this study was initiated. The prevalence rate of each of these ocular conditions increased with age. Prevalence of senile cataracts ranged from 4.6% for those between the ages of 52 to 64 years to 46% for those 75 to 85 years of age. Diabetic retinopathy was present in 2% of those between 52 and 64 years of age or older. Overall prevalence of senile macular degeneration was 9%, with a prevalence rate of 2% in our youngest age group and 28% in the oldest age group. Open-angle glaucoma had an overall prevalence of approximately 3%. This disease also showed a statistically significant (P less than .01) increase with age from 1.4% (52 to 64 years old) to 7.2% (75 to 85 years old).

Diabetes, blood lipids, and the role of obesity in coronary heart disease risk for women. The Framingham study.

Diabetes and a low high-density lipoprotein cholesterol level are associated with each other and with a higher coronary heart disease risk in women. Moreover, both are strongly associated with obesity. These findings are reported from the Framington Study, in which persons aged 49 to 82 were characterized, after overnight fast, for blood lipids by the method of Fredrickson and Levy and then followed for the subsequent development of coronary heart disease. Low-density lipoprotein cholesterol was also associated with coronary heart disease risk in women, but fasting triglycerides were not associated with risk after allowing for the association with high-density lipoprotein cholesterol and diabetes. A low high-density lipoprotein cholesterol in the presence of diabetes appeared to raise the coronary heart disease risk in women relative to that of men.

Predicting coronary heart disease in middle-aged and older persons. The Framington study.

Of 1,025 men and 1,445 women, aged 49 to 82 years, who were free of coronary heart disease (CHD), 79 men and 63 women subsequently had CHD. Using a risk function based on cholesterol in the high density and low density lipoproteins, systolic blood pressure, left ventricular hypertrophy, and diabetes, less than 2% of the subsequent CHD cases were found in the lowest decile of risk, whereas 25% of the cases for men and 37% for women were found in the highest decile. Predictability held for each specific age group. This predictability was at least as good as that obtained by the usual CHD risk profile at younger ages.