Abstract

Epidemiological studies are classified into descriptive, analytical, and experimental or clinical trials. Descriptive studies quantify the distribution of disease or characteristics of individuals within defined populations such as a geographic area or an occupational group. This distribution is often related to the characteristics of both the individual such as age, race, and sex and the environment. Analytical studies are of two broad types, retrospective or case-control and longitudinal or prospective. The goal of analytical studies is to determine the relationship between a defined independent variable or a risk factor, and a disease or dependent variable, or certain other characteristics of the individual. The variables initially measured are called the independent variables and the outcome, dependent variables. The experimental or clinical trials modify the independent variables in order to determine the effects on a dependent variable or outcome. The science of epidemiology deals primarily with the determinants of epidemics and the evaluation of methods of their control and prevention. The epidemiological methods are useful for the study of most diseases whether traditional acute, usually infectious diseases, or the longer-incubation-period, chronic diseases. The descriptive and analytical studies are of primary importance in determining the magnitude of the epidemic in relationship to time, place, and personal characteristics and the identification of probable risk factors of disease. Most of the interest in behavioral variables relates to diseases that have relatively long incubation periods, are difficult to accurately measure, and are often believed to have a “multifactorial” etiology. Often the estimated relative risk of any single variable is low and may be inconsistent from study to study. Many of these diseases have a relatively long incubation period prior to apparent clinical disease. Many also may have a relatively high prevalence of inapparent as compared to clinical disease. During the long incubation period, physiological changes may occur that result in modification of other risk factors for the disease. For example, weight loss and certain nutritional changes may occur years before the diagnosis of cancer. It is possible that metabolic changes at the cellular level may be the reasons for some of these early physiologic changes such as the weight loss. The subsequent weight loss as well as other nutritional changes and the cellular metabolic abnormalities then result in a substantial fall in the serum cholesterol levels. Measurement prospectively in a population study then is noted to have an inverse relationship with the subsequent risk of cancer (Sherwin et al., 1987). The longer the time between cholesterol measurement and either the incidence or death from cancer, the weaker is the relationship between cholesterol and cancer.

Keywords

Coronary Heart Disease Smoking Cessation Usual Care Intervention Trial Coronary Heart Disease Mortality 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Blackburn, H., & Leon, A. (1986). Preventive cardiology in practice: Minnesota studies of risk factor reduction. In M. Pollock & D. Schmidt (Eds.), Heart disease and rehabilitation (2nd ed., pp. 265–301). New York: Wiley.Google Scholar
  2. Brown, M. S., & Goldstein, J. L. (1976). Receptor-mediated control of cholesterol metabolism. Science, 191, 150–154.PubMedCrossRefGoogle Scholar
  3. Bunker, C. H. (1987, March 19-21). Are blood pressure and obesity related through salt transport and insulin? Abstract prepared for the American Heart Association 27th Annual Conference on Cardiovascular Disease Epidemiology.Google Scholar
  4. Cornfield, J. (1978). Randomization by group: A formal analysis. American Journal of Epidemiology, 108(2), 100–189.PubMedGoogle Scholar
  5. Dai, W. S., Kuller, L. H., & Miller, G. (1984). Arterial blood pressure and urinary electrolytes. Journal of Chronic Diseases, 37(1), 75–84.PubMedCrossRefGoogle Scholar
  6. Farquhar, J. W. (1978). The community-based model of lifestyle intervention trials. Journal of Epidemiology, 108(2), 103–111.Google Scholar
  7. Friedlander, Y., Kark, J. D., & Stein, Y. (1985). Religious orthodoxy and myocardial infarction in Jerusalem: A casecontrol study. International Journal of Cardiology, 10, 33–41.CrossRefGoogle Scholar
  8. Friedman, G. D., Collen, M. F., & Fireman, B. H. (1986). Multiphasic health check-up evaluation: A 16 year follow-up. Journal of Chronic Diseases, 39(6), 453–463.PubMedCrossRefGoogle Scholar
  9. Friedman, L. M., Furberg, C. D., & DeMets, D. L. (1982). Sample size. In Fundamentals of clinical trials (pp. 69–88). Boston: John Wright.Google Scholar
  10. Harker, L. A. (1986). Clinical trials evaluating platelet-modifying drugs in patients with atherosclerotic cardiovascular disease and thrombosis. Circulation, 73(2), 206–223.PubMedCrossRefGoogle Scholar
  11. Hjermann, I., Holme, I., Velve-Byre, K., & Leren, P. (1981). Effect of diet and smoking intervention on the incidence of coronary heart disease: Report from the Oslo Study Group of a randomized trial in healthy men. Lancet, 2, 1303–1310.PubMedCrossRefGoogle Scholar
  12. Jacobs, D. R., Luepker, R. V., Mittlemark, M. B., Folsom, A. R., Pirie, P. L., Mascioli, S. R., Hannan, P. J., Pechacek, T. F., Bracht, N. F., Carlaw, R. W., Kline, F. G., & Blackburn, H. (1986). Community-wide prevention strategies: Evaluation of the Minnesota Heart Health Program. Journal of Chronic Diseases, 39(10), 775–788.PubMedCrossRefGoogle Scholar
  13. James, S.A. (1985). Psychosocial and environmental factors in black hypertension. In W. D. Hall, E. Saunders, & N. B. Shulman (Eds.), Hypertension in blacks: Epidemiology, pathophysiology, and treatment (pp. 132–143). Chicago: Year Book Medical.Google Scholar
  14. Kaplan, B. H., Cassel, J. C., Tyroler, H. A., Cornoni, J. C., Kleinbaum, D. G., & Harnes, C. G. (1971). Occupational mobility and coronary heart disease. Archives of Internal Medicine, 128, 938–948.PubMedCrossRefGoogle Scholar
  15. Kuller, L. H. (1986). Natural history of coronary heart disease. In M. Pollock & D. Schmidt (Eds.), Heart disease and rehabilitation (2nd ed., pp. 29–52). New York: Wiley.Google Scholar
  16. Kuller, L. H., Perper, J. A., Dai, W. S., Rutan, G., & Traven, N. (1986). Sudden death and the decline in coronary heart disease mortality. Journal of Chronic Diseases, 39(12), 1001–1019.PubMedCrossRefGoogle Scholar
  17. Lefebvre, R. C., Lasater, T. M., Carleton, R. A., & Peterson, G. (1987). Theory and delivery of health programming in the community: The Pawtucket Heart Health Program. Preventive Medicine, 16, 80–95.PubMedCrossRefGoogle Scholar
  18. Levy, R. I., Brensike, J. F., Epstein, S. E., Kelsey, S. F., Passamani, E. R., Richardson, J. M., Loh, I. K., Stone, N. J., Aldrich, R. F., Battaglini, J. W., Moriarty, D. J., Fisher, M. L., Friedman, L., Friedewald, W., & Detre, K. M. (1984). The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: Results of the NHLBI Type II Coronary Intervention Study. Circulation, 68, 325–337.CrossRefGoogle Scholar
  19. Lewis, H. D., Davis, J. W., Archibald, D. G., Steinke, W. E., Smitherman, T. C., Doherty, J. E., III, Schnaper, H. W., Le Winter, M. M., Linares, E., Pouget, J. M., Sabharwal, S. C., Chesler, E., & DeMots, H. (1983). Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study. New England Journal of Medicine, 309, 396–403.PubMedCrossRefGoogle Scholar
  20. Lyon, J. L., Wetzler, H. P., Gardner, J. W., Klauber, M. R., & Williams, R. R. (1978). Cardiovascular mortality in Mormons and non-Mormons in Utah, 1969–1971. American Journal of Epidemiology, 108(5), 357–368.PubMedGoogle Scholar
  21. Meinert, C. L. (1986). Clinical trials: Design, conduct, and analysis. London: Oxford University Press.Google Scholar
  22. Miller, G. J., Martin, J. C., Webster, J., Wilkes, H., Miller, N. E., Wilkinson, W. H., & Meade, T. W. (1986). Association between dietary fat intake and plasma factor VII coagulant activity—a predictor of cardiovascular mortality. Atherosclerosis, 60, 269–277.PubMedCrossRefGoogle Scholar
  23. Moss, A. J. (1980). Prediction and prevention of sudden cardiac death. Annual Review of Medicine, 31, 1–14.PubMedCrossRefGoogle Scholar
  24. Multiple Risk Factor Intervention Trial Research Group (1982). Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results. Journal of the American Medical Association, 248(12), 1465–1477.CrossRefGoogle Scholar
  25. Pearson, T. A. (1984). Coronary arteriography in the study of the epidemiology of coronary artery disease. Epidemiology Review, 6, 140–266.Google Scholar
  26. Phillips, R. L., Kuzma, J. W., Beeson, W. L., & Lotz, T. (1980). Influence of selection versus lifestyle on risk of fatal cancer and cardiovascular disease among Seventh-Day Adventists. American Journal of Epidemiology, 112(2), 296–314.PubMedGoogle Scholar
  27. Puska, P., Salonen, J. T., Tuomilehto, J., Nissinen, A., & Kottke, T. E. (1983). Evaluating community-based preventive cardiovascular programs: Problems and experiences from the North Karelia Project. Journal of Community Health, 9(1), 49–64.PubMedCrossRefGoogle Scholar
  28. Rautaharju, P. M., Prineas, R. J., Eifler, W. J., Furberg, C. D., Neaton, J. D., Crow, R. S., Stamler, J., & Cutler, J. A. (1986). Prognostic value of exercise electrocardiogram in men at high risk of future coronary heart disease: Multiple Risk Factor Intervention Trial experience. Journal of the American College of Cardiology 8(1), 1–10.PubMedCrossRefGoogle Scholar
  29. Research Group of the Rome Project of Coronary Heart Disease Prevention (1986). Eight year follow-up results from the Rome Project of Coronary Heart Disease Prevention. Preventive Medicine, 15, 176–191.CrossRefGoogle Scholar
  30. Rose, G., Hamilton, P. J. S., Colwell, L., & Shipley, M. J. (1982). A randomized controlled trial of anti-smoking behavior change among smokers in the Multiple Risk Factor Intervention Trial (MRFIT). Preventive Medicine, 11, 621–638.CrossRefGoogle Scholar
  31. Royal College of General Practioners’ Oral Contraception Study (1981). Further analysis of mortality in oral contraceptive users. Lancet, 1, 541–546.Google Scholar
  32. Ruberman, W., Weinblatt, E., Goldberg, J. D., & Chaudhary, B. S. (1984). Psychosocial influences on mortality after myocardial infarction. New England Journal of Medicine, 311, 552–559.PubMedCrossRefGoogle Scholar
  33. Salonen, J. T., Kottke, T. E., Jacobs, D. R., & Hannan, P. J. (1986). Analysis of community-based cardiovascular disease prevention studies—Evaluation issues in the North Karelia Project and the Minnesota Heart Health Program. International Journal of Epidemiology, 15(2), 176–182.PubMedCrossRefGoogle Scholar
  34. Schulze, R. A., Humphries, J. D., Griffith, L. S. C., Ducci, H., Achuff, S., Baird, M. G., Mellits, E. D., & Pitt, B. (1977). Left ventricular and coronary angiographic anatomy: Relationship to ventricular irritability in the late hospital phase of acute myocardial infarction. Circulation, 55, 839–843.PubMedCrossRefGoogle Scholar
  35. Shapiro, S., Venet, W., Strax, P., Venet, L., & Rosser, R. (1982). Ten to fourteen year effect of screening on breast cancer mortality. Journal of the National Cancer Institute, 69, 349–355.PubMedGoogle Scholar
  36. Sherwin, R. W., Kaelber, C.T., Kezdi, P., Kjelsberg, M. O., & Thomas, H. E., for MRFIT (1981). The Multiple Risk Factor Intervention Trial (MRFIT): The development of the protocol. Preventive Medicine, 10, 402–425.PubMedCrossRefGoogle Scholar
  37. Sherwin, R. W., Wentworth, D. N., Cutler, J. A., Hulley, S. B., Kuller, L. H., & Stamler, J., for the MRFIT Group (1987). Serum cholesterol and cancer mortality in the 361, 662 men screened for the Multiple Risk Factor Intervention Trial. Journal of the American Medical Association, 257, 943–948.PubMedCrossRefGoogle Scholar
  38. Stamler, J. (1980). Data base on the major cardiovascular diseases in the United States. In R. Hegyeli (Ed.), Atherosclerosis reviews: Vol. 7. Measurement and control of cardiovascular risk factors. New York: Raven Press.Google Scholar
  39. Syme, S. L., Marmot, M. G., Kagan, A., Kato, H., & Rhoads, G. (1975). Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: Introduction. American Journal of Epidemiology, 102(6), 477–490.PubMedGoogle Scholar
  40. Talbott, E., Kuller, L. H., Detre, K., & Perper, J. A. (1980). Sudden death due to arteriosclerotic disease: A study of women. In H. E. Kulbertus & H. J. J. Wellens (Eds.), Sudden death. Hingham, MA: Kluwer Boston.Google Scholar
  41. Thorn, T. J., Epstein, F. H., Feldman, J. J., & Leaverton, P. E. (1985). Trends in total morbidity and mortality from heart disease in 26 countries from 1950–1978. International Journal of Epidemiology, 14, 510–520.CrossRefGoogle Scholar
  42. Ueshima, H., Iida, M., Shimamoto, T., (1982). Dietary intake and serum total cholesterol level: Their relationship to different lifestyles in several Japanese populations. Circulation, 66(3), 519–526.PubMedCrossRefGoogle Scholar
  43. U.S. Department of Health and Human Services (1983). Cerebrovascular disease. In Cardiovascular Disease: The Health Consequences of Smoking (pp. 157-175). Surgeon General Report. Washington, DC: U.S. Government Printing Office.Google Scholar
  44. Verrier, R. L., & Lown, B. (1982). Experimental studies of psychophysiological factors in sudden cardiac death. Acta Medica Scandinavia Supplementum, 660, 57–68.Google Scholar
  45. Zahavi, I., Goldbourt, U., Cohen-Mandelzweig L., Katz, M., Appel, S., Harel, G., Sperling, Z., Lazarovici, M., Hart, J., & Neufeld, H. N. (1987). Distributions of total cholesterol, triglycerides, and high-density lipoprotein cholesterol in Israeli Jewish children of different geographic-ethnic origins ages 9–17 years. Preventive Medicine, 16, 35–51.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1989

Authors and Affiliations

  • Lewis H. Kuller
    • 1
    • 2
  1. 1.Department of EpidemiologyUniversity of PittsburghPittsburghUSA
  2. 2.Graduate School of Public HealthPittsburghUSA

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