Profiling risk: the emergence of coronary heart disease epidemiology in the United States (1947–70)

Abstract

This historical study examines the development of coronary heart disease (CHD) research and its role in the evolution of post-1945 chronic disease epidemiology in the United States. To give the examination greater salience, it compares the pathway represented by CHD epidemiology with that of lung cancer. Historians have paid less attention to the differences between the two, which later merged into what we now call 'risk factor epidemiology'. This study assesses why CHD epidemiology in the post-war period almost uniformly began with cohort studies and primarily stressed clinical variables as putative aetiological factors. It describes how CHD epidemiologists sought to justify the creation of a non-infectious chronic disease epidemiology, a position reinforced by the relative swiftness with which they obtained important results. It also follows the emergence of 'risk factor thinking' within CHD epidemiology. CHD epidemiology critically differed from its lung cancer counterpart in that it identified multiple factors of risk, each producing relatively small effects, rather than a single factor producing a strong and evident outcome. Consequently, it was difficult for CHD epidemiologists to demonstrate causality and to confirm scientifically that reducing risk factors would lower CHD rates. This had significant consequences for primary prevention and public health policy.

Elevated Plasma Platelet Activating Factor, Platelet Activating Factor Acetylhydrolase Levels and Risk of Coronary Heart Disease or Blood Stasis Syndrome of Coronary Heart Disease in Chinese: A Case Control Study

“…In our study, elevated age, BMI and uric acid; positive family history of hypertension and CHD; smoking; high fasting glucose; and high LDL-C and TC levels were the risks of CHD. These findings are in accordance with those of the previous studies [30][31][32]. Furthermore, further analysis found in our present study that the PAF levels were obviously different among populations with different BMI, smoking status and uric acid levels.…”

The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective

“…39,40 Having recovered from the funding crisis, Framingham investigators were now ready to adapt an approach of ‘epidemiological activism’ with a focus on hypertension. 41 …”

The mutual shaping of life insurance and medicine in Finland

“…The concept of risk factor was introduced in the early 1960s in the context of the Framingham study on cardiovascular health (Oppenheimer, 2006). Despite the danger of anachronism, I feel the concept warrants its use here, since the factors were deployed to estimate the probability of future health problems and diminished life expectancy in individuals and calculate their costs.…”