Prospective assessment of coronary heart disease risk factors: The NHANES I epidemiologic follow-up study (NHEFS) 16-year follow-up

Objective: Our specific aim in the 16 year prospective NHANES I epidemiologic follow-up study (NHEFS) was to assess the important roles of modifiable dietary and behavioral factors in causation and prevention of deaths and hospitalizations for coronary heart disease (CHD). Methods: Using NHEFS 16 year follow-up data (1971 to 1987), we studied 5811 subjects, 1958 with and 3853 without CHD events, using logistic regression. Results: In age groups 40 to 49, 50 to 59, 60 to 69, and 70 to 74 years (at study entry in 1971-4), the numbers of men and women were respectively 597 and 1019, 570 and 619, 932 and 1042, and 486 and 546. The following factors were independently positively associated (p<.05) with CHD: age, serum cholesterol, body mass index, cigarette use, and region (Midwest, Northeast). The following factors were independently negatively associated (p<.05) with CHD: gender (female), race (black), fish intake, alcohol, high school education, moderate exercise, and moderate and heavy habitual physical activity. Subjects with serum cholesterol >249 mg/dl benefitted less (p=.04) from fish intake than those with 209 to 249 or <209, and benefitted less (p=.03) from alcohol intake (CHD incidence [%]): GRAPHICS Conclusions: These associations emphasize the important role of modifiable dietary and behavioral factors in the causation and prevention of CHD.