Hulley S B
Clinical Epidemiology Program, University of California, San Francisco.
Drugs. 1988;36 Suppl 3:1-4. doi: 10.2165/00003495-198800363-00003.
Several recent advances in our understanding of the epidemiology and prevention of coronary artery disease are presented, highlighting the current status of the 3 major risk factors: blood cholesterol, blood pressure and cigarette smoking. There is a striking analogy between serum cholesterol and diastolic blood pressure in the pattern of the association with coronary heart disease (CHD). Mortality follow-up of the 361,662 middle-aged men screened for the Multiple Risk Factor Intervention Trial (MRFIT) shows that each of these risk factors identifies a large group of patients (the top 15% of the population distribution) who have a 4-fold higher risk of CHD death than those in the bottom 15%, and that each has a continuously rising gradient of risk for people with intermediary levels. The implication from these findings, and from the clinical trial data, is that public health and clinical policies directed at blood cholesterol should be made similar to those that have become widespread for blood pressure in the past 2 decades; i.e. measuring the level periodically in all adults and intervening to prevent CHD in those at highest risk. The public health campaign to reduce cigarette smoking has been bolstered by new evidence on the hazards of ambient smoke. One example comes from the clinical trial cohort of the MRFIT, in which non-smoking men who were married to smoking wives had nearly twice the all-cause mortality rate of non-smoking men who were married to non-smoking wives.(ABSTRACT TRUNCATED AT 250 WORDS)
