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20-Year Findings From the Honolulu Heart Program

Robert J. Goldberg, PhD; Cecil M. Burchfiel, PhD; Richard Benfante, PhD; Darryl Chiu, MS; Dwayne M. Reed, MD, PhD; Katsuhiko Yano, MD

Arch Intern Med. 1995;155(7):686-694.

Abstract
Objectives
: To examine the association between a variety of baseline lifestyle and biologic factors in a middle-aged cohort of Japanese-American men and the 20-year incidence rates of total atherosclerotic end points and each of the initial clinical manifestations of this disease, including fatal and nonfatal coronary heart disease, angina pectoris, thromboembolic strokes, and aortic aneurysms.

Design
Prospective epidemiologic study.

Population
Japanese-American men (N=2710) between the ages of 55 and 64 years at the time of the initial clinical examination of the Honolulu Heart Program (1965 through 1968) free from evidence of coronary heart disease, cerebrovascular disease, cancer, or aortic aneurysms.

Results
Among the men studied, 602 atherosclerotic events developed during the 23-year period of follow-up (1965 through 1988). After adjustment for each of the baseline characteristics examined, significant positive associations between quartile cutoffs of body mass index, systolic blood pressure, serum levels of cholesterol, triglycerides, glucose, and uric acid, as well as cigarette smoking, and the occurrence of any atherosclerotic end point were seen, while an inverse association with alcohol consumption was observed. Characteristics associated with the development of other fatal and nonfatal clinical events in this cohort, including coronary heart disease, thromboembolic stroke, and aortic aneurysms are presented with accompanying relative and attributable risks.

Conclusions
The results of this prospective epidemiologic study provide insights to the long-term predictive utility of the commonly accepted risk factors for coronary heart disease in relation to the different clinical manifestations of atherosclerosis in a middle-aged male cohort followed up for approximately 20 years. These results provide additional support for risk factor modification in middle-aged men and for the encouragement of positive long-term lifestyle changes.

(Arch Intern Med. 1995;155:686-694)

Author Affiliations
From the Department of Medicine, University of Massachusetts Medical School, Worcester (Dr Goldberg); the Honolulu (Hawaii) Epidemiology Research Section, Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, (Dr Burchfiel); the Buck Center for Research in Aging, Novato, Calif (Dr Reed); and the Honolulu Heart Program, Kuakini Medical Center, Honolulu (Drs Benfante and Yano and Mr Chiu).

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