Showing papers by "Ralph B. D'Agostino published in 1989"

Blood pressure as a risk factor for cardiovascular disease. The Framingham Study--30 years of follow-up.

Abstract: Data from 30 years of follow-up of the original Framingham Study cohort of 5,070 men and women aged 30-62 years who were first examined during the period 1948-1952 and who were free of cardiovascular disease reveal that blood pressure is a strong and consistent predictor of the development of coronary heart disease, stroke, transient ischemic attack, and congestive heart failure. Other factors related to blood pressure like obesity, left ventricular hypertrophy as demonstrated on electrocardiograms, and heart enlargement as shown by x-ray radiography made several selective additional independent contributions to risk; heart enlargement by x-ray radiography was the best predictor of congestive heart failure.

Prevalence of silent stroke in patients presenting with initial stroke: the Framingham Study.

Abstract: It is common to find computed tomography scan evidence of prior stroke without a history of such an event. The frequency, risk factors for, and relevance of silent strokes are unknown. The Framingham cohort of 5,184 men and women aged 30-62 years and free of stroke at entry to the study have been followed with periodic examinations since 1950. We studied the silent strokes found on computed tomography scan of all initial strokes that occurred between January 1, 1979, and July 31, 1987. During these 8 1/2 years, 164 initial strokes occurred; 124 had computed tomography scans performed. There were 13 (10%) with silent stroke, 71 had abnormalities related to their presenting acute stroke, and 40 had normal computed tomography scans. There were 15 silent lesions; eight were lacunar infarcts in the basal ganglia-internal capsule area, seven were small cortical infarcts. Glucose intolerance was the sole risk factor that occurred significantly more frequently (11 of 13) in the group with silent lesions (p less than 0.04) than in the group with computed tomography evidence of acute stroke. Silent stroke is not rare; it was present in at least 10% of acute initial stroke patients arising in a general population. The relation of these silent lesions to the development of "vascular" dementia and poststroke disability deserves further study.

Time Course of Functional Recovery After Stroke: The Framingham Study:

Abstract: The time course for functional recovery following stroke has not been well defined. To obtain an unbiased picture, we studied the pace of recovery using standardized neurological, functional, and cognitive tests in stroke survivors in the Framingham cohort over a 4½-year period. Of 119 patients who developed new strokes, 67 survived 1 year; of these, 46 were evaluated at onset, and at 3, 6, and 12 months poststroke. Significant recovery was documented in the Barthel Index, mobility, self-care, and language. This occurred chiefly during the first 3 months, with marginal gains thereafter. Multivariate analyses revealed no differences in the pattern of recovery with regard to clinical or demographic characteristics. These data from a community-based study document improvement in physical function over a relatively short period of time after stroke onset. Focusing treatment and rehabilitation within this specific time period may enhance eventual outcome for stroke survivors. Key Words: Cerebrovascular disease...

Trends in CHD and Risk Factors at Age 55–64 in the Framingham Study

Abstract: In a preliminary analysis to assess secular changes in cardiac morbidity, mortality, and risk factors in the Framingham Heart Study, there is a suggestion of decline in coronary heart disease (CHD) mortality in women but not in men. For subjects age 55 to 64 in 1953, 1963 and 1973, the ten-year CHD mortality rates per 1000 were 93, 84 and 99 for men; and 34, 39, and 24 for women, respectively. In contrast, CHD prevalence rates have increased significantly for men (102, 134 and 159 per 1000) and marginally for women (55, 65 and 69 per 1000). Incidence of CHD increased slightly in men (187, 210 and 208 per 1000 over the three decades) and decreased in women (131, 132, 110). Some coronary risk factors improved, while others changed unfavourably.

Using survival methods to estimate age‐at‐onset distributions for genetic diseases with an application to Huntington disease

Abstract: Two important considerations in genetic disease are the risk of inheriting the gene for a disease and the age-at-onset distribution among those inheriting it. This paper describes the use of survival data analytic methods to estimate these entities. When a sample consists of children and/or siblings of affected individuals, standard life-table methods such as Kaplan-Meier techniques can be applied. The desired estimators are functions of the Kaplan-Meier estimator and their properties are derived using the invariance principle and delta methods. A discussion of the underlying assumptions and estimators of standard errors and mean onset age are given. In an application to Huntington disease, the risk (+/- SE) of inheriting the gene for disease among children of a singly affected parent is estimated to be 0.499 +/- 0.020 and the estimated mean onset age (+/- SE) is 45.6 +/- 0.7.