W B Kannel

The effects of specific medical conditions on the functional limitations of elders in the Framingham Study.

OBJECTIVES The purpose of this study was to identify associations between specific medical conditions in the elderly and limitations in functional tasks; to compare risks of disability across medical conditions, controlling for age, sex, and comorbidity; and to determine the proportion of disability attributable to each condition. METHODS The subjects were 709 noninstitutionalized men and 1060 women of the Framingham Study cohort (mean age 73.7 +/- 6.3 years). Ten medical conditions were identified for study: knee osteoarthritis, hip fracture, diabetes, stroke, heart disease, intermittent claudication, congestive heart failure, chronic obstructive pulmonary disease, depressive symptomatology, and cognitive impairment. Adjusted odds ratios were calculated for dependence on human assistance in seven functional activities. RESULTS Stroke was significantly associated with functional limitations in all seven tasks; depressive symptomatology and hip fracture were associated with limitations in five tasks; and knee osteoarthritis, heart disease, congestive heart failure, and chronic obstructive pulmonary disease, were associated with limitations in four tasks each. CONCLUSIONS In general, stroke, depressive symptomatology, hip fracture, knee osteoarthritis, and heart disease account for more physical disability in noninstitutionalized elderly men and women than other diseases.

Epidemiologic assessment of chronic atrial fibrillation and risk of stroke The fiamingham 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 incidence, 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.

Diabetes and cardiovascular risk factors: the Framingham study

The impact of cardiovascular disease was compared in non-diabetics and diabetics in the Framingham cohort. In the first 20 years of the study about 6% of the women and 8% of the men were diagnosed as diabetics. The incidence of cardiovascular disease among diabetic men was twice that among nondiabetic men. Among diabetic women the incidence of cardiovascular disease was three times that among nondiabetic women. Judging from a comparison of standardized coefficients for the regression of incidence of cardiovascular disease on specified risk factors, there is no indication that the relationship of risk factors to the subsequent development of cardiovascular disease is different for diabetics and non-diabetics. This study suggests that the role of diabetes as a cardiovascular risk factor does not derive from an altered ability to contend with known risk factors

Diabetes and Glucose Tolerance as Risk Factors for Cardiovascular Disease: The Framingham Study

This report examines prospectively, in the Framingham cohort, the relation of diabetes and impaired glucose tolerance to each of the cardiovascular sequelae, taking into account age, sex, and associated cardiovascular risk factors. The incidence of cardiovascular disease, as well as the levels of cardiovascular risk factors, were found to be higher in diabetic than in nondiabetic men and women. The relative impact of diabetes on coronary heart disease, peripheral vascular disease, or stroke incidence was the same in men and women, but for cardiovascular mortality and cardiac failure the impact is greater for women. Present evidence suggests that alleviation of associated cardiovascular risk factors is the most promising course in reducing cardiovascular sequelae in diabetic patients.

Update on Some Epidemiologic Features of Intermittent Claudication: The Framingham Study

During 26 years of surveillance of the Framingham Study Cohort of 5,209 subjects, 176 men and 119 women developed occlusive peripheral arterial disease manifested as intermittent claudication (IC). The incidence increased sharply with age until the age of 75, with about a twofold male predominance at all ages. An incidence of IC comparable to that of angina pectoris was obtained ten years later in life than for angina pectoris. Cigarette smoking, impaired glucose tolerance, and hypertension were powerful predisposing factors. Impaired glucose tolerance was a greater risk in women than in men, and glycosuria carried a greater risk than other indicators of impaired glucose tolerance. Cigarette smoking had about the same impact in men and women, approximately doubling the risk, and the impact was discernible into advanced age. Hypertension increased risk 2.5‐ to fourfold, respectively, in men and women. A low vital capacity was associated with a substantial excess risk. Electrocardiographic evidence of left ventricular hypertrophy predicted IC in both sexes. Serum cholesterol, relative weight, and hematocrit were weak risk factors. A risk profile made up of the major cardiovascular risk factors was better for predicting IC than for predicting coronary heart disease. Mortality was increased two‐ to fourfold in men and women, respectively, mainly because of coexistent cardiovascular disease. J Am Geriatr Soc 33:13, 1985

Precursors of sudden coronary death. Factors related to the incidence of sudden death.

Precursors of sudden death were sought in men--1838 civil servants in Albany, New York, and 2282 residents of Framingham, Massachusetts--under continuous surveillance for 16 years. In men 45-74 years old there were 234 deaths attributed to coronary heart disease (CHD) of which 109 occurred within one hour of onset of symptoms. More than half of all deaths due to CHD occurred outside the hospital and about 80 per cent of these were sudden. Most were unheralded by prior symptoms of CHD. Persons at high risk of death from CHD, including sudden death, can be identified long before the terminal unexpected catastrophe. The same precursive stigmata exist in persons subject ot coronary attacks whether or not immediately fatal. The risk of sudden death in these two populations was positively correlated with high blood pressure, the electrocardiographic pattern of left ventricular enlargement, obesity, and heavy cigarette usage. Sudden death is a common and possibly incidental expression of lethal coronary heart disease. The potential candidate for sudden death cannot be confidently distinguished from the individual who succumbs more slowly of myocardial infarction. The inescapable conclusion is that the prevention of sudden death requires the prevention of coronary attacks.

High density lipoprotein cholesterol, total cholesterol screening, and myocardial infarction. The Framingham Study.

The relation between high density lipoprotein cholesterol (HDL-C) and the development of myocardlal Infarction was examined In 2425 subjects, aged 50 to 79 years, who were enrolled In the Framingham Study from 1969 to 1971. After 12 years of follow-up, men in the bottom three quartiles of HDL-C (<52 mg/dl) experienced a 60% to 70% excess of myocardlal Infarction as compared to men whose HDL-C levels were higher (p<0.05). The effect of HDL-C was especially strong In women. In separate comparisons to the 4th quartlle of HDL-C (> 67 mg/dl), the risk of myocardial Infarction Increased from a fourfold excess In the adjacent 3rd quartlle (56 to 66 mg/dl, p<0.01) to a nearly sixfold excess In the 1st quartile (<46 mg/dl, p < 0.001). These results persisted after adjusting for age and other risk factors. In addition, a significant effect of HDL-C remained In subjects who had the lowest concentrations of total cholesterol (=s 192 mg/dl In men and 211 mg/dl In women) In which 29% had levels of HDL-C (s 36 mg/dl In men and 46 mg/dl In women) that were associated with a marked elevation In the Incidence of myocardlal Infarction. We conclude that screening for total cholesterol alone In men and women aged 50 and older may not adequately Identify the coronary candidate. In addition, selective screening of HDL-C only for Individuals with high concentrations of total cholesterol can leave the false Impression that low total cholesterol Is uniformly associated with a healthy risk profile.

Subarachnoid and intracerebral hemorrhage: Natural history, prognosis, and precursive factors in the Framingham Study

No uniformly accepted hypothesis explains the genesis and rupture of intracranial aneurysms. We followed 5,184 men and women prospectively for 26 years; 36 cases of aneurysmal subarachnoid hemorrhage (SAH) accounted for 62% of all intracranial hemorrhages. Blood pressure before SAH was higher in these patients than in controls. Definite hypertension (2160 mm Hg and/or 295 mm Hg) at entry to the study or at closest exam before SAH was more frequent than in controls. Cigarette smoking, particularly heavy smoking, was also more frequent among cases.

An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas

Aim: To determine whether the Framingham function accurately predicts the 10 year risk of coronary disease and to adapt this predictive method to the characteristics of a Spanish population. Method and Results: A Framingham function for predicting 10 year coronary deaths and non-fatal myocardial infarction was applied to the population of the province of Gerona, Spain, where the cumulated incidence rate of myocardial infarction has been determined since 1988 by a specific registry. The prevalence of cardiovascular risk factors in this region of Spain was established in 1995 by a cross sectional study on a representative sample of 1748 people. The number of cases estimated by the Framingham function for 10 year coronary deaths and non-fatal myocardial infarction was compared with that observed. The Framingham function estimated 2425 coronary heart disease cases in women and 1181 were observed. In men, 9919 were estimated and 3706 were observed. Recalibrating the Framingham equations to the event rate and the prevalence of the risk factors in Gerona led to estimates very close to the number of cases observed in Gerona men and women. Conclusions: The Framingham function estimates more than doubled the actual risk of coronary disease observed in north east Spain. After calibration, the Framingham function became an effective method of estimating the risk in this region with low coronary heart disease incidence.

Duration of atrial fibrillation and imminence of stroke: the Framingham study.

The role of Atrial Fibrillation (AF) as a precursor of stroke was examined in the Framingham cohort based on 30 years of follow-up during which time 501 strokes occurred. There were 59 persons who sustained stroke in association with AF excluding those with rheumatic heart disease. AF increased the risk of stroke five-fold and the excess risk was found to be independent of the frequently associated cardiac failure and coronary heart disease. The contribution of AF to stroke risk was also at least as powerful as that of the other cardiovascular precursors. Stroke associated with AF was not only independent and substantial but also imminent. There was a distinct clustering of stroke events at the time of onset of the AF. Thirty day case-fatality rates were no different in those with strokes accompanied by AF than not at 17% versus 19% respectively. Recurrences in those with AF were only slightly more frequent, 25% versus 20%, a difference that was not statistically significant. Stroke recurrence in the first 6 months following initial stroke was more than twice as common (47% versus 20%) in the AF group.