| Titre : | Cardiovascular Disease. From Framingham to North Karelia to U.S. Community Prevention Programs: Negotiating Research Agendas for Coronary Heart Disease in the Second Half of the 20th Century. (2011) |
| Auteurs : | OPPENHEIMER (Gérald M.) ; Henry BLACKBURN ; Pekka Puska |
| Type de document : | Article |
| Dans : | Public Health Reviews (vol. 33, n° 2, 2011) |
| Pagination : | 450-483 |
| Langues: | Anglais |
| Mots-clés : | Epidémiologie ; Histoire santé ; Etats Unis ; Appareil circulatoire [pathologie] ; Cardiopathie ; Cardiopathie coronaire ; Maladie chronique ; Facteur risque ; Finlande ; Programme communautaire ; Epidémiologie clinique ; Recherche |
| Résumé : | In the United States in 1948, the newly formed National Heart Institute (NHI) funded the application of epidemiology to study of coronary heart disease (CHD). With federal encouragement, CHD epidemiologists enriched research designs, helped develop the randomized controlled trial. Epidemiologists developed longitudinal studies meant to determine the relationship between well-measured clinical variables and subsequent CHD events. Here, consistent associations within and across populations, eventually reinforced by analyses of pooled data from multiple cohort investigations, demonstrated the existence of well-founded risk factors, but left open the question of causal inference based on observed relationships. After substantial ambivalence, the U.S. government, under pressure from epidemiologists, committed to an agenda of clinical trials to test that proposition. In addition, the results of the cohort studies elicited a demand by epidemiologists for a broader, population-wide approach, testing whether community-level models of risk factor modification through broad cultural change would demonstrate a reduction in the probability of disability and premature death from heart attack. To tell the story of the community studies and to analyze outcomes, we focus on the Minnesota Heart Health Program and the Finnish North Karelia Project. |
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