Sex and time trends in cardiovascular disease incidence and mortality: The Framingham Heart Study, 1950-1989

Abstract

Variations in cardiovascular disease mortality between sexes, over time, and across regions point to population differences in the biologic, behavioral, and environmental factors influencing cardiovascular health. The authors examined 20-year trends in risk factors, incidence, and mortality among women and men in Framingham, Massachusetts, who were members of the Framingham Heart Study and aged 50-59 years in 1950, 1960, and 1970. The incidence declined 21% between the female cohorts (p < 0.01 for trend) with the greatest decline occurring between the 1950 and 1960 cohorts. The 20- year incidence declined only 6% between the male cohorts despite an 18% decline (p < 0.05 for trend) during the first 10 years of follow-up. Cardiovascular disease mortality declined 59% between the female cohorts and 53% between the male cohorts (both p < 0.001 for trend). The largest mortality declines occurred between the 1950 and 1960 female cohorts during the second 10 years of follow-up and between the 1960 and 1970 male cohorts during both follow-up periods. Obesity, hypercholesterolemia, and high blood pressure were significantly lower at baseline and 10 years later in the 1970 female cohort compared with the 1950 cohort (all p < 0.001). Smoking and high blood pressure were significantly lower at baseline and 10 years later in the 1970 male cohort compared with the 1950 cohort (both p < 0.001). More than half of the 51% decline in coronary heart disease mortality observed in women between 1950 and 1989 and one third to one half of the 44% decline observed in men could be attributed to improvements in risk factors in the 1970 cohorts.