Life history of cardiovascular disease and its risk factors : multistate life table approach and application to the Framingham Heart Study

This book aims at contributing to the study of chronic diseases and the debate on compression versus expansion of morbidity by applying a new methodology that integrates demography and epidemiology and by deriving indicators of cardiovascular disease history. The long-term impact of four risk factors on cardiovascular disease is investigated using the 48 years follow-up of the original Framingham Heart Study cohort. Four disease types are distinguished: coronary heart disease (CHD), myocardial infarction (MI), congestive heart failure (CHF) and stroke. The risk factors that are studied are smoking, blood pressure, body mass index, and serum cholesterol. These risk factors at middle age are strong predictors of the incidence of cardiovascular disease and mortality at older age. The study shows that a healthy life style postpones cardiovascular disease and may reduce the lifetime risk of the disease. The human life course offers an exciting new paradigm for multidisciplinary scientific research. The study of individual disease histories and risk factors during different stages of life leads to new insights in the impact of lifestyle on health at older age. The adoption of the new paradigm necessitates longitudinal data and appropriate data analtyic techniques. This book demonstrates that a combination of the multistate life table and multivariate techniques of event history modeling provide3s an effective way to describe, explain and predict disease histories.