Saturday, March 28, 2020

Risk Factors for Coronary Artery Disease live report on aaj tak



Aajtak live report on Coronavirus.

We consider our current understanding and therapy of cardiovascular diseases (CVD) state-of-the-art, but heart disease is still a problem because there is still a lot that we do not know. There is still no cure for any form of heart disease. However, research is ongoing, and new clues are emerging which could lead to better treatments in the future. Results from epidemiological studies, foremost among them the Framingham study, have been crucial to our current knowledge about CVD. Emphasis is on the identification of risk factors, assessment of their predictive ability, and their implications for disease prevention.
The concept of “risk factors” in coronary heart disease (CHD) was first coined by the Framingham heart study (FHS), which published its findings in 1957. FHS demonstrated the epidemiologic relations of cigarette smoking, blood pressure, and cholesterol levels to the incidence of coronary artery disease (CAD). The findings were truly revolutionary for it helped bring about a change in the way medicine is practiced.

Beginnings of our understanding

For thousands of years, our knowledge of the causes of CVD and its therapy was static. It was only in the last half of the 20th century that research into the causes of CVDs accelerated, and with it, new therapies were found.
What stimulated this research? The premature death in 1945 of the US President Franklin D. Roosevelt from hypertensive heart disease and stroke stimulated this research in USA.[] Deaths from CVD and stroke reached epidemic proportions in the USA at that time which induced the Americans to take the lead in cardiovascular research.
The death of President Roosevelt illustrated how little we knew about the general causes of heart disease and stroke. Therefore, a health project was set up in the USA– the FHS – to identify the common factors or characteristics that contribute to CVD. FHS was under the direction of the National Heart Institute, now known as the National Heart, Lung, and Blood Institute.[] Researchers followed the development of CHD over a long period in a large group of participants who had not yet developed overt symptoms of CVD or suffered a heart attack or stroke. The small town of Framingham in Massachusetts, USA was chosen due to its geographical proximity to the many cardiologists at Harvard Medical School. Furthermore, the residents had already participated in the Framingham tuberculosis demonstration study two decades earlier.[]
The town of Framingham is located outside Boston. It was a small, middle-class community, and its small population made it an ideal site to launch the heart study. Everybody knew everyone. It was a typical small-town in the USA. The researchers hoped they would find clues in the medical histories of the people of Framingham which might shed light on causes of CVD. They recruited 5,209 men and women between the ages of 30 and 62 from the town of Framingham, Massachusetts. These study subjects underwent extensive physical examinations and lifestyle interviews that were analyzed for common patterns related to CVD development. Since 1948, the subjects have continued to return to the study every 2 years for a detailed medical history, physical examination, and laboratory tests, and in 1971, the study enrolled a second generation-5,124 of the original participants' adult children, and their spouses to participate in similar examinations.[] The FHS is now on its third generation of participants. The study has provided substantial insight into the epidemiology of CVD and its risk factors.

Framingham study leads the way

The Framingham study was responsible for pointing out fallacies in our understanding of CVDs and identification of its major risk factors: high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity as well as other valuable information on the effects of related factors such as blood triglyceride and high density lipoprotein (HDL) cholesterol levels, age, gender, and psychosocial issues. To date, no single risk factor has been identified to be responsible for causing CVD; rather, multiple interrelated factors seem responsible for its development. Although the Framingham cohort is Caucasian, other studies have shown that the major risk factors identified in this group apply universally to other racial and ethnic groups.
The notion of CVD risk factors is an integral part of modern medicine which has led to the development of effective treatment and preventive strategies in clinical practice.


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