The Framingham Heart Study

CHD is a major cause of death and disability in developed countries. Although the mortality for this condition has gradually declined over the last decades in western countries, it still causes about one-third of all deaths in people older than 35 years.(Sanchis-Gomar et al., 2016) The Framingham Heart Study perfectly summarizes the risk factors that contribute to the development of CHD, providing critical information regarding objectives for the primary and secondary prevention of CHD (figure 6). Figure (6): Natural history of cardiovascular diseases and its correspondence with some lifestyle and biochemical/physiological characteristics considered risk factor for these diseases. CRP indicates C-reactive protein; CVD, cardiovascular disease;
The estimated annual incidence of heart attack in the US is 580,000 new attacks and 210,000 recurrent attacks and the average age at the first heart attack is 65.3 years for males and 71.8 years for females. From 2004 to 2014, the annual death rate attributable to coronary heart disease declined 35.5% but the burden and risk factors remain alarmingly high. .(Benjamin EJ, Blaha MJ,
In a 2009 report that used National Health and Nutrition Examination Survey (NHANES) data, MI prevalence was compared by sex in middle-aged individuals (35–54 years) during the 1988–1994 and 1999– 2004 time periods (Towfighi, Zheng and Ovbiagele, 2009). The prevalence of MI was higher in men compared with women in the two periods, but it tended to decline in the former over time, whilst the opposite trend was found in women. Some data based on self-reported MI and angina from health interviews, such as those from the NHANES, might underestimate the actual prevalence of advanced CHD. This is likely to be due, at least partly, by the fact that advanced occlusive CHD often exists with few symptoms or overt clinical manifestations. Silent ischemia, which accounts for 75% of all ischemic episodes (19) (Deedwania and Carbajal,