Sex and time trends in cardiovascular disease incidence and mortality: the Framingham Heart Study, 1950-1989.
Level 3 - non-randomized controlled study
Prospective multi-cohort comparative study tracking sequential population cohorts over time
PubMed 8633618 · doi:10.1093/oxfordjournals.aje.a008748
What was done
Authors examined 20-year trends in cardiovascular disease (CVD) risk factors, incidence, and mortality across three sequential cohorts of men and women in Framingham, Massachusetts, who were aged 50–59 years in 1950, 1960, and 1970, followed through 1989.
What was found
Twenty-year CVD incidence fell 21% in women (p < 0.01 for trend; largest drop between the 1950 and 1960 cohorts) and 6% in men (though men had an 18% decline during the first 10 years of follow-up, p < 0.05). CVD mortality decreased by 59% in women and 53% in men (both p < 0.001 for trend). Compared to the 1950 cohort, the 1970 female cohort had lower rates of obesity, hypercholesterolemia, and high blood pressure (all p < 0.001), while the 1970 male cohort had lower rates of smoking and high blood pressure (both p < 0.001). Risk factor improvements accounted for more than half of the 51% drop in coronary heart disease mortality in women and 33% to 50% of the 44% decline in men.
Why it matters
This study provides long-term epidemiological evidence that substantial declines in cardiovascular mortality during the mid-to-late 20th century were directly linked to secular improvements in modifiable risk factors.
Limits
The abstract does not state the sample size (n). Findings reflect a single, predominantly White geographic cohort (Framingham, MA) and may not generalize to diverse racial, ethnic, or socioeconomic populations. Residual confounding from unmeasured medical treatments or lifestyle changes cannot be excluded.
Cited by
- supports Cardiovascular disease mortality has dropped from approximately half of all deaths in the 1950s to approximately one-third of deaths currently.