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Longitudinal study of heart disease in a Jamaican rural population. 2. Factors influencing mortality
Insights
High blood pressure and signs of heart ischemia significantly increase mortality risk in rural Jamaicans. However, hypertension alone did not raise mortality within the 5-year study period.
Area of Science:
- Epidemiology
- Cardiology
- Public Health
Background:
- Cardiovascular disease is a leading cause of death globally.
- Understanding risk factors in diverse populations is crucial for targeted interventions.
- Rural communities may face unique health challenges and access to care.
Purpose of the Study:
- To investigate the relationship between cardiovascular risk factors and mortality in a rural Jamaican population.
- To identify specific predictors of death related to heart disease.
- To assess the prognostic significance of hypertension, effort pain, and ECG abnormalities.
Main Methods:
- An epidemiological study followed 918 adults in rural Jamaica for 5 years.
- Data collected included arterial pressure, electrocardiographic (ECG) abnormalities, and reported effort pain.
- Mortality data and causes of death were analyzed in relation to baseline cardiovascular characteristics.
Main Results:
- Cardiovascular disease, particularly heart disease, was the primary cause of death.
- Elevated blood pressure (≥160/95 mm Hg) was prevalent in deceased individuals, showing a clear trend with overall mortality.
- Symptoms of effort pain and ECG abnormalities indicative of myocardial ischemia were common and independently predicted mortality, especially when combined with hypertension.
Conclusions:
- Hypertension, effort pain, and ECG abnormalities suggesting ischemia are significant mortality predictors in this rural Jamaican cohort.
- While hypertension alone did not increase mortality in this study, its combination with other cardiovascular indicators worsened prognosis.
- Myocardial disorders resembling ischemic heart disease are a substantial cause of death in rural Jamaicans, even in the absence of classical myocardial infarction.
Abstract:
The relationship between cardiovascular characteristics and mortality was investigated in an epidemiological study of heart disease in a representative adult rural community in Jamaica. Of 449 men and 469 women followed up for 5 years, 36 men and 28 women died and the data concerning their status as regards arterial pressure, electrocardiographic abnormalities, and histories of effort pain at the intial survey have been analysed. Cardiovascular disease, and heart disease in particular, was the major cause of death in this population. Blood pressure levels exceeding 160/95 mm Hg had been recorded in about one third of the men and half the women who died and a clear trend was found between overall mortality and arterial pressure. Symptoms of effort pain and ECG abnormalities compatible with myocardial ischaemia, both of which were unexpectedly common, appeared to have independent prognostic significance. The prognosis of each was worse when associated with hypertension; hypertension unaccompanied by either effort pain or ECG "ischaemic" abnormality, on the other hand, caused no excess mortality in either sex within the period of follow-up. Although classical myocardial infarction was confirmed to be relatively infrequent, myocardial disorders with many of the features of ischaemic heart disease are an important cause of death in rural Jamaicans.