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UBC Theses and Dissertations

Coronary heart disease risk factor methodology and prevention/intervention strategies Jones, Wayne Nelson


Coronary heart disease has been a serious health problem for the last 50+ years. Due to the magnitude of this problem, successful prevention and/or intervention strategies are greatly needed. One potentially successful intervention or prevention strategy is the reduction of risk factors for coronary heart disease. Since 1967 the primary way of describing risk factors for the development of coronary heart disease has been through the use of logistic analysis. While this model has produced valuable results, certain problems must be overcome before a feasible intervention or prevention program could be developed. Prospective studies examining the development of coronary heart disease were started in the 1950's. Four main risk factors were identified in these studies: increasing age, serum cholesterol level, elevated blood pressure, and smoking. However, a large number of other variables in one or another of these studies were also found to be risk factors, and other methods of analysis were needed. While the logistic model was first used to analyze selected results of a-coronary heart disease prospective study in 1961, widespread use of the model did not begin until after 1967. Since then, most prospective studies have included some form of logistic analysis of their data. These analyses have consistently found smoking, serum cholesterol, blood pressure, and age to be statistically significant risk factors for the development of coronary heart disease. This paper examines the model of coronary heart disease that has developed out of the use of the logistic function as a method of analyzing the data collected in prospective coronary heart disease studies. The focus of this thesis is on the usefulness of the model as a tool in the development of coronary heart disease prevention or intervention programs that might be created in the near future. Demonstration of a causal relationship between a risk factor and the development of coronary heart disease has not been explored in as much detail. Only two of the prospective studies that are attempting to lower risk factors have been completed. One study was not able to show a statistically significant improvement in mortality rates for the experimental area. The other study indicates that lowering an individual's serum cholesterol level lowered the coronary heart disease morbidity rate. Other studies should be completed in the near future, and this issue may become clarified. Some of the potential problem areas that exist for any prevention or intervention program that is based on a logistic model include selection of the appropriate equation, selection of specific details of an intervention or prevention strategy, and selection of the target levels of the risk factors. Once these problems are dealt with a viable intervention or prevention program could be developed.

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