A survey of 246 suggested coronary risk factors

Hopkins, Paul N.; Williams, Roger R.

doi:10.1016/0021-9150(81)90122-2

Cited by 321 publications

(112 citation statements)

References 626 publications

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“…Imagine we test 1000 null hypotheses of no difference between experimental and control treatments. There is some evidence that the null only rarely is false, namely that only rarely the treatment under study is effective (either superior to a placebo or to the usual treatment) or that a factor under observation has some prognostic value [12,19,20]. Say that 10% of these 1000 null hypotheses are false and 90% are true [20].…”

Section: Misconceptions When Considering Statistical Resultsmentioning

confidence: 99%

“…The requirement to register trials before the first patient is included may prove to be an important means to deter this issue. For instance, by 1981, 246 factors had been reported [12] as potentially predictive of cardiovascular disease, with many having little or no relevance at all, such as certain fingerprints patterns, slow beard growth, decreased sense of enjoyment, garlic consumption, etc. More than 25 years later, only the following few are considered clinically relevant in assessing individual risk: age, gender, smoking status, systolic blood pressure, ratio of total cholesterol to high-density lipoprotein, body mass index, family history of coronary heart disease in first-degree relatives younger than 60 years, area measure of deprivation, and existing treatment with antihypertensive agent [19].…”

Section: Implications For Researchmentioning

confidence: 99%

See 1 more Smart Citation

P Value and the Theory of Hypothesis Testing: An Explanation for New Researchers

Biau

Jolles

Porcher

2010

Clinical Orthopaedics &Amp; Related Research

142

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In the 1920s, Ronald Fisher developed the theory behind the p value and Jerzy Neyman and Egon Pearson developed the theory of hypothesis testing. These distinct theories have provided researchers important quantitative tools to confirm or refute their hypotheses. The p value is the probability to obtain an effect equal to or more extreme than the one observed presuming the null hypothesis of no effect is true; it gives researchers a measure of the strength of evidence against the null hypothesis. As commonly used, investigators will select a threshold p value below which they will reject the null hypothesis. The theory of hypothesis testing allows researchers to reject a null hypothesis in favor of an alternative hypothesis of some effect. As commonly used, investigators choose Type I error (rejecting the null hypothesis when it is true) and Type II error (accepting the null hypothesis when it is false) levels and determine some critical region. If the test statistic falls into that critical region, the null hypothesis is rejected in favor of the alternative hypothesis. Despite similarities between the two, the p value and the theory of hypothesis testing are different theories that often are misunderstood and confused, leading researchers to improper conclusions. Perhaps the most common misconception is to consider the p value as the probability that the null hypothesis is true rather than the probability of obtaining the difference observed, or one that is more extreme, considering the null is true. Another concern is the risk that an important proportion of statistically significant results are falsely significant. Researchers should have a minimum understanding of these two theories so that they are better able to plan, conduct, interpret, and report scientific experiments.

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Section: Misconceptions When Considering Statistical Resultsmentioning

confidence: 99%

Section: Implications For Researchmentioning

confidence: 99%

P Value and the Theory of Hypothesis Testing: An Explanation for New Researchers

Biau

Jolles

Porcher

2010

Clinical Orthopaedics &Amp; Related Research

142

View full text Add to dashboard Cite

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“…Estas afecções caracterizam-se geralmente por uma etiologia multifatorial e pelo incipiente estado do conhecimento sobre os mecanismos etiológicos e fisiopatológicos que levam ao seu surgimento e desenvolvimento, o que dificulta uma intervenção sistemática e coerente a nível de saúde pública. Entretanto, estudos epidemiológicos têm mostrado consistentemente uma relação entre determinados fatores e determinadas doenças 18,26,45,74,75,77,81 . Além disto, tem-se verificado que a remoção ou reversão da exposição a estes fatores implica na redução da mortalidade e/ou da prevalência e/ou o surgimento mais tardio das patologias em estudo 5,40 .…”

Section: Introductionunclassified

Fatores de risco para doenças crônicas não-transmissíveis: inquérito domiciliar no Município de São Paulo, SP (Brasil). Metodologia e resultados preliminares

et al. 1990

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REGO, R.A. et al. Fatores de risco para doenças crônicas não-transmissíveis: inquérito domiciliar no Município de São Paulo, SP (Brasil). Metodologia e resultados preliminares. Rev. Saúde públ., S. Paulo, 24: 1990. RESUMO:As doenças crionicas não-transmissíveis são causa importante de morte no Brasil, principalmente nos grandes centros urbanos. Existem inúmeros fatores de risco relacionados a este tipo de doenças, cuja remoção, ou atenuação, pode contribuir para o declínio da mortalidade. Descreve-se a metodologia do primeiro estudo muiticêntrico abrangente realizado na América Latina sobre a questão dos fatores de risco de doenças crônicas não-transmissíveis. No Brasil o estudo foi realizado nos municípios de São Paulo, SP e Porto Alegre, RS. São apresentados resultados preliminares para o Município de São Paulo quanto à prevalência de hipertenção arterial (22,3%), tabagismo (37,9%), obesidade (18,0%), alcoolismo (7,7%) e sedentarismo (69,3%). Os resultados obtidos são comparados com dados existentes para o Brasil e outros países, e discute-se a relação entre a magnitude dos diversos fatores de risco e a mortalidade por doenças cardiovasculares em São Paulo e alguns países desenvolvidos. DESCRITORES: INTRODUÇÃOAs doenças crônicas não-transmissíveis constituem uma das principais causas de morte nos países desenvolvidos 38,40,62 Entre as doenças cardiovasculares, vem-se percebendo um declínio, nos últimos anos, na mortalidade relativa à doença isquémica do coração (DIG) 35,43,59,65,82 , e à doença cerebrovascular 41,42,58 , que entretanto não abala a posição deste grupo de doenças como um dos principais componentes da morbimortalidade. Apesar de ainda estar em discussão o que realmente levou a essa queda nas taxas, tem-se atribuído tal fato basicamente a : a) diminuição da exposição aos fatores de risco, como o consumo de cigarros e a ingestão de gorduras animais 5,16,35,44,78,79 ; e b) melhorias no diagnóstico, tratamento e cobertura dos serviços de saúde em relação à hipertensão e outras doenças cardiovasculares 4,39,41 .A expressão "fator de risco" refere-se a um conceito que vem ganhando importância crescente no campo das doenças crônicas não-transmissíveis 23,63,66 . Estas afecções caracterizam-se geralmente por uma etiologia multifatorial e pelo incipiente estado do conhecimento sobre os mecanismos etiológicos e fisiopatológicos que levam ao seu surgimento e desenvolvimento, o que dificulta uma intervenção sistemática e coerente a nível de saúde pública. Entretanto, estudos epidemiológicos têm mostrado consistentemente uma relação entre determinados fatores e determinadas doenças 18,26,45,74,75,77,81 . Além disto, tem-se verificado que a remoção ou reversão da exposição a estes fatores implica na redução da mortalidade e/ou da prevalência e/ou o surgimento mais tardio das patologias em estudo 5,40 . Desta maneira, a intervenção

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“…Clearly, the issue of RF is still open for discussion. In 1981, Hopkins and Williams 85 identified 246 possible coronary RF. It is possible that even more may be discovered.…”

Section: Risk Factorsmentioning

confidence: 99%

Chronic Coronary Artery Disease

Thelen¹,

Erbel²,

Kreitner³

et al. 2009

Cardiac Imaging

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State of the ArtCoronary insufficiency (CI) is the state in which an imbalance occurs between the supply and demand of oxygen, which prevents adequate maintenance of the metabolic needs of the myocardium, resulting in ischemia of several degrees of intensity.CI has numerous causes among which are cardiac valvular diseases (aortic stenosis), hypertrophic cardiomyopathy, microvasculature diseases (diabetes mellitus, syndrome X), anomalous origin of coronary arteries, and coronary fistulas. However, the most important cause, because of its frequency and the resulting morbidity and mortality, is atherosclerotic obstructive CI. Therefore, this discussion will be specifically about coronary atherosclerosis. The main objective is not to suggest practical applications for specific situations, but to outline concepts, based on critical analysis of data in the literature, which may provide a basis for conducting further investigation and for providing treatment of coronary artery disease (CAD). PathophysiologyHuman atherosclerosis is a chronic, progressive and systemic process characterized by an inflammatory and fibroproliferative response of the arterial wall caused by aggression against the arterial surface. As a systemic process, it frequently attacks all arterial beds, including the aorta and its main branches: carotid, renal, iliac and femoral arteries. Among the risk factors (RF) for arterial lesions are hypercholesterolemia, arterial hypertension (AH), diabetes, smoking, immunological and inflammatory reactions, and individual genetic susceptibility 1 .The coronary vascular alterations present in atherosclerosis derive from three fundamental components: 1) endothelial dysfunction, which starts early, altering the reactivity of the vessel and causing paradoxical vasoconstriction following stimuli with acetylcholine, and exacerbation of reactivity to epinephrine and angiotensin; endothelial dysfunction also leads to loss of the natural antithrombotic properties and of the selective permeability of the endothelium; 2) obstruction of the lumen of the vessel by the atherosclerotic plaque and 3) thrombosis at the location of the lesion. Any of these could individually trigger CI, but they often occur at the same time. Response of the arterial wall to aggressive agentsEndothelial cells play several physiological roles in maintaining the integrity of the arterial wall and constitute a permeable barrier through which diffusion and exchanges or active transportation of several substances occur. They provide a non-thrombogenic and non-adhesive surface for platelets and leukocytes; they operate to maintain vascular tonus by releasing nitric oxide (NO), prostacyclin (PGI 2 ) and endothelin-1; they produce and discharge growth factors and cytokines and maintain the integrity of the basal membrane rich in collagen and proteoglycans on which they are supported 2 . Alterations in one or more of these functions represent initial manifestations of endothelial dysfunctions and may trigger cellular interactions with monocytes, platele...

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A survey of 246 suggested coronary risk factors

Cited by 321 publications

References 626 publications

P Value and the Theory of Hypothesis Testing: An Explanation for New Researchers

P Value and the Theory of Hypothesis Testing: An Explanation for New Researchers

Fatores de risco para doenças crônicas não-transmissíveis: inquérito domiciliar no Município de São Paulo, SP (Brasil). Metodologia e resultados preliminares

Chronic Coronary Artery Disease

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