William J. Zukel

The Effect of Treatment on Mortality in Mild Hypertension: Results of the Hypertension Detection and Follow-up Program

In the Hypertension Detection and Follow-up Program, 7825 (71.5 per cent) of the 10,940 participants had diastolic blood pressures averaging between 90 and 104 mm Hg on entry into the study and were designated Stratum 1. Half were referred to their usual source of care in the community (the referred-care group), and half were treated intensively in special clinics (the stepped-care group). Five-year mortality in the Stratum 1 patients given stepped care was 20.3 per cent lower than in those given referred care (P less than 0.01). Particularly noteworthy was the beneficial effect of stepped-care treatment on persons with diastolic pressures of 90 to 104 mm Hg who had no evidence of end-organ damage and were not receiving antihypertensive medication when they entered the study. This subgroup had 28.6 per cent fewer deaths at five years among those treated with stepped care than among those treated with referred care (P less than 0.01). These findings support a recommendation that in patients with mild hypertension, treatment should be considered early, before damage to end organs occurs.

Frequency of alcohol consumption and morbidity and mortality. The Yugoslavia cardiovascular disease study.

The association of frequency of alcohol consumption with the seven-year incidence of coronary heart-disease and with mortality both from all causes and from specific causes was examined in a cohort of 11 121 Yugoslav males aged 35-62 at the time of their initial examination. Consumption of alcohol seemed to be inversely related to incidence of coronary heart-disease morbidity and mortality, but not to risk of dying. Those consuming alcoholic beverages most frequently were at increased risk of death from stroke and accidents or violence. The frequency of alcohol consumption was associated with high blood-pressure and serum cholesterol levels. The associations with coronary heart disease and death from all causes could not be fully explained by these covariates.

The multiple risk factor intervention trial (MRFIT)

Abstract The beginnings of the Multiple Risk Factor Intervention Trial (MRFIT) for the primary prevention of coronary heart disease (CHD) are chronicled. Over the period 1960–1970, various scientific panels had urged the undertaking of primary CHD prevention trials but with limited consensus on the specific type of study needed. The Task Force on Arteriosclerosis convened by the National Heart and Lung Institute (NHLI) in 1971 recommended that a national diet-heart trial not be supported but, instead, that the NHLI undertake multiple risk factor intervention trials in individuals at high risk of CHD due to combinations of elevated serum lipids, hypertension, and cigarette smoking. Late in 1971, the NHLI invited proposals for MRFIT. Its primary purpose was to determine whether a special risk factor intervention program directed at the reduction of elevated serum cholesterol, elevated diastolic blood pressure, and cigarette smoking in men at high risk of death from CHD (but still free of clinical evidence of CHD) would result in a significant reduction in CHD mortality; nonfatal myocardial infarction or CHD mortality; cardiovascular mortality; and mortality from all causes—over a 6-year period. In 1972–1973, funds to conduct such a study among 12,000 randomized men were awarded to 22 clinical centers, a coordinating center, central laboratory, standardization laboratory, ECG centers, and a drug distribution center. The evolution of the organization of this research undertaking is described.

Socioeconomic differentials in prognosis following episodes of coronary heart disease

Abstract Survival of first admissions to Army hospitals for coronary heart disease occurring from June 1943 to December 1944 was evaluated in a sample of 1495 white males who were alive 6 months after the date of admission. Included in this study are only cases whose hospital diagnosis was confirmed by an independent review of the history, laboratory data, and ECG recordings in their service medical records. Physicians were found to have a better prognosis than other occupations. When physicians were excluded, professional men with college education had a somewhat better survival than other occupation or education groupings. Physicians were more likely to have the diagnosis of angina pectoris or coronary insufficiency than others; however, their favorable prognosis was also found within diagnostic groups with specified ECG findings. The much better long-term survival of physicians may give some measure of the extent to which early detection and appropriate medical regimens can improve prognosis in coronary heart disease if followed by optimally motivated patients.

Epidemiology of coronary heart disease among young army males of World War II

Abstract An epidemiologic study was carried out on 1,393 cases of CHD in World War II Army men, median age 39.6 years, by comparing these cases with representative age-matched Army controls using data from military records of both groups, particularly records of induction into service. Factors showing significant (P Other characteristics more prevalent among the coronary cases than among the matched controls and therefore associated with a higher risk of CHD were: geographical residence in the Middle Atlantic States, a higher socioeconomic score, some graduate education, being an officer, being of Jewish religion, and having a blood Group A. A significantly lower risk of CHD was found for rural birthplace and previous outdoor occupation requiring high physical activity. Men whose previous occupation was that of a farmer or farm laborer had a relative risk of 0.54 (P

Screening for Cardiovascular Disease in a Community

TO discover persons with a high probability of cardiovascular disease and refer them to their physicians for diagnosis and treatment, a case-finding program was started in Newton, Massachusetts, in...