The World Health Organization lists ischemic heart disease and stroke as the top 2 leading causes of death worldwide in 2011, responsible for 7 million and 6.2 million deaths, respectively.1 The concept of risk factors for atherosclerotic cardiovascular disease (CVD) was introduced in 1961, based on epidemiologic observations from the Framingham Heart Study. Hypertension and abnormal blood lipid levels were key risk factors shown to be associated with an increased risk of angina pectoris, myocardial infarction, and sudden cardiac death; later, stroke was identified as an important outcome as well, especially in women and racial/ethnic subgroups. Accordingly, clinicians want to provide their patients with the best possible advice with respect to the management of cardiovascular risk, often implementing evidence-based clinical practice guidelines designed to improve health outcomes.
The biologic continuum of disease progresses from ideal health through the development of risk factors (eg, hypertension, hypercholesterolemia) and the transition to disease (eg, atherosclerosis) with development of outcome events (eg, myocardial infarction, stroke). Three categories (A, B, C) of RCTs illustrate the available evidence reviewed by committees for clinical practice guidelines. In epidemiologic observational studies, patients enter the study cohort at different stages along the continuum and vary in the duration they are at risk for an outcome event. The proposed solution to the limitations of the current evidence base is to embed randomized trials in large free-living cohorts of patients who enter the trial and are randomized at different stages throughout the biologic continuum. See text.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
JAMA: 2014-03-26, Vol. 311, No. 12, Author Reading
More Listings atJAMACareerCenter.com >
The Rational Clinical Examination EDUCATION GUIDES
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.