BACKGROUND:

Coronary heart disease is the leading cause of death among United States Blacks, where coronary heart disease mortality rates are among the highest in the world. There has been a marked decline in coronary heart disease mortality among Blacks in the United States including South Carolina since 1968 for reasons not well explained, although hypertension control probably has contributed to the decline. In spite of this decline, evidence emerged that fatal and non-fatal coronary heart disease rates in Blacks exceeds those of whites.

Charleston Heart Study data showed that coronary heart disease cumulative survival probabilities for Black men were lower than white men during the first 20 years of the 25 year observation period. A secular trend manifested itself with relatively higher rates in Blacks but in any event, there was evidence that coronary disease was a major threat to Blacks.

The Charleston Heart Study was initiated in 1960. Randomly selected Black and white men and women 35 years of age and over were examined to obtain details concerning angina, myocardial infarction, hypertension, smoking, blood pressure, height, weight, and serum cholesterol levels. The total cohort was 2,283 persons. The last screening of the cohort was in 1974-1975 until the this study which started in 1984.

Over one half the Blacks in the United States live in the South and the Charleston Heart Study offered the opportunity to study disease and disability status of elderly Blacks, in an environment that included urban and rural residents.

DESIGN NARRATIVE:

In 1984-1985 a 25 year follow-up was conducted on the original Charleston Heart Study cohort. The vital status of 98 percent of the 1960 cohort was ascertained. Ninety-three percent of the survivors were revisited, interviewed, and measured for blood pressure, weight, and height. The interaction of socioeconomic status, type A behavior and John Henry behavior scores were tested. All-cause and coronary heart disease mortality were determined.

In 1987-1988 approximately 1,300 survivors were recalled for measurements of functional and cognitive status using the Framingham Functional Disability Questionnaire so that comparisons of results from Charleston and Framingham could be made. Measurements were made of blood pressure, height, weight, and heart function by auscultation, ECG, and echocardiography. Lipoproteins, glucose, and other biochemical parameters were assessed.

The biomedical and sociodemographic determinants of long-term survival in Black men and women were quantified and compared with those of whites. The risk factor significance of Minnesota-coded ECG abnormalities in Blacks versus whites were identified and quantified. Familial aggregation of risk factors and potential causes of obesity were assessed.