Cardiovascular Diseases Clinical Trial
To identify and evaluate genetic and non-genetic determinants of coronary heart disease (CHD), atherosclerosis, and their risk factors in ongoing population-based epidemiology studies. The multicenter study was conducted in three phases which were: Phase I, the family history component: Phase II, the clinical examination and follow-up component; and Phase III, the molecular genetic and genetic epidemiology studies component.
BACKGROUND:
Advances in molecular genetics, genetic epidemiology, population genetics, and
identification of new risk factors and clusters of risk factors for cardiovascular disease
made 1991 an opportune time to take advantage of the extensive information about
cardiovascular disease, pre-clinical atherosclerosis, and risk factors in individuals who
had been examined in ongoing, state-of-the-art epidemiological studies supported by the
NHLBI. By recruiting first degree relatives of random samples of such defined populations,
FHS obtained information about familial aggregation, genetic and environmental contributions
to variance in continuous variables, and the frequency and distribution of elevated levels
of risk factors and of selected major genes in the general population.
The FHS was initiated by staff and approved by the Clinical Applications and Prevention
Advisory Commitee in May, 1990. The Requests for Proposals were released in July 1991.
Contracts were awarded in June, 1992.
DESIGN NARRATIVE:
During Phases I and II from May 1992-May 1996, probands, aged 45-69, were recruited from the
Framingham Heart Study, the Utah Family Tree Study and the North Carolina and Minnesota
sites of the ARIC Study, along with their relatives, for participation in the Family Heart
Study. Two groups of probands were selected, either randomly or by a high family risk of CHD
as calculated from data from the parent study. Additional family structure and disease
history data were collected on 3,150 probands and 22,909 of their relatives. Clinical
examination and follow-up of these random and high CHD risk families were conducted on a
total of 1,253 families including 5,975 individuals, of whom 102 families including 265
individuals were African-American. The examinations included information on anthropometry,
blood pressure, ECG, carotid ultrasound, pulmonary function, and blood chemistries.
Questionnaire data included medical and reproductive histories, diet, physical activity,
tobacco and alcohol consumption, education, income and psychosocial factors including
hostility, social support and stress. Phases I and II included four field centers, a
coordinating center, and a central blood laboratory.
In August 1996, Phase III began when cooperative agreements were awarded to a consortium of
seven investigator-initiated grants to conduct molecular genetic and genetic epidemiology
studies using data collected during Phases I and II. Phase III ended in July 2001. The
objective of Phase III was to perform molecular genetic and genetic epidemiology studies
using the extensive data on family and medical histories, risk factors, life style, blood
specimens, and banked DNA previously collected by the FHS. Studies included novel molecular
genetics of candidate genes and genome-wide searches with anonymous markers for the
detection, mapping, and characterization of coronary heart disease and atherosclerosis
genes. Genetic epidemiology analyses were conducted that contributed new information on the
familial aspects of atherosclerosis and intermediate phenotypes in African Americans. Phase
III also included four field centers, a central laboratory, a molecular genetics laboratory,
and a coordinating center.
The study was renewed in 2001 as the Family Heart Study - Subclinical Atherosclerosis
Network (FHS-SCAN) to complete analyses of genome-wide scan data and to genotype promising
markers. The study expects to enroll 401 informative pedigrees (3,027 individuals)
previously examined and genotyped by the NHLBI Family Heart Study to quantify coronary and
aortic calcium volume in order to identify genes associated with atherosclerosis. In
addition, 315 African American sibships (770 individuals) previously examined and comparably
genotyped by the Hypertension Epidemiology Network (HyperGEN) will be examined at one study
center to address these study questions in this minority population.
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