Cardiovascular Health Study (CHS) Cohort: an NHLBI-funded observational study of risk factors for cardiovascular disease in adults 65 years or older

Objectives

The Cardiovascular Health Study (CHS) is a study of risk factors for development and progression of CHD and stroke in people aged 65 years and older. The objectives of the Cardiovascular Health Study are to: 1) quantify associations of conventional and hypothesized risk factors with CHD and stroke; 2) assess the associations of non-invasive measures of subclinical disease with the incidence of CHD and stroke; 3) quantify the associations of risk factors with subclinical disease; 4) characterize the natural history of CHD and stroke, and identify factors associated with clinical course; and 5) describe the prevalence and distributions of risk factors, non-invasive measures of subclinical disease, and clinical CHD and stroke.

Background

The study originated in 1988 from the recommendations of an NHLBI workshop on the management of CHD in the elderly. This is the most extensive study undertaken by the NHLBI to study CVD exclusively in an elderly population. Initially funded for six years, it was renewed for a second six year period in 1994 and recently was renewed with limited support for the Coordinating Center, the Laboratory and the Steering Committee. Grant funding from several sources has supported an additional clinic visit in 2005-2006 and continued morbidity and mortality follow-up.

Subjects

The 5,888 study participants were recruited from four U.S. communities and have undergone extensive clinic examinations for evaluation of markers of subclinical cardiovascular disease. The original cohort totaled 5,201 participants. A new cohort was recruited in 1992. The 687 participants in the new cohort are predominately African-American and were recruited at three of the four field centers.

Design

The 2,962 women and 2,239 men were examined yearly from 1989 through 1999. The added minority cohort of 256 men and 431 women was examined from 1992 to 1999. Examination components have included medical history questionnaires, measurement of ankle-brachial index, abdominal and carotid ultrasound studies, echocardiograms, ambulatory electrocardiograms, cerebral magnetic resonance imaging, spirometry and retinal photographs over the past decade. The most extensive evaluations were at study entry (baseline) and again in 1992-1993 to assess change in subclinical disease measures. CHS has undertaken extensive follow-up for ascertainment of cardiovascular events including incident claudication, myocardial infarction, congestive heart failure, stroke and death.

Genetic Research

The Cardiovascular Health Study has expanded its research mission into the study of genetic factors underlying CVD and other disorders using DNA that was collected from blood samples from most participants. Subsets of CHS participants have been genotyped in large-scale genotyping projects, including thousands of SNP genotypes for candidate gene regions as part of the NHLBI Candidate gene Association Resource (CARe) and genome-wide genotyping as part of the NHLBI SNP Typing for Association with Multiple Phenotypes from Existing Epidemiologic Data (STAMPEED). Whole exome sequencing of an overlapping subset of CHS participants was performed through the NHLBI "Grand Opportunity" Exome Sequencing Project (GO-ESP).

The Cardiovascular Health Study Cohort is utilized in the following dbGaP substudies. To view genotypes, analysis, expression data, other molecular data, and derived variables collected in these substudies, please click on the following substudies below or in the "Substudies" section of this top-level study page phs000287 Cardiovascular Health Study Cohort.

• Study Weblinks:
  • CHS
• Study Design:
  • Prospective Longitudinal Cohort
• Study Type:
  • Longitudinal
• Total number of consented subjects: 5609
• Subject Sample Telemetry Report (SSTR)

The four Field Centers of the Cardiovascular Health Study (CHS) are located in Forsyth County, NC; Sacramento County, CA; Washington County, MD; and Pittsburgh, PA. In June 1990, four Field Centers completed the recruitment of 5201 participants. In June 1993, an additional 687 African Americans were recruited using similar methods. Each community sample was obtained from random samples of the Medicare eligibility lists of the Health Care Financing Administration (HCFA). Eligible to participate were persons living in the household of each sampled individual who were: 1) aged 65 years or older; 2) non-institutionalized; 3) expected to remain in the area for 3 years; and 4) able to give informed consent. Excluded were those wheelchair-bound, receiving hospice care or cancer treatment. The minority cohort was recruited using similar methods. Participants were eligible whether or not they had clinically apparent cardiovascular disease.

CHS is an NHLBI contract-funded cohort study designed to evaluate risk factors for coronary heart disease (CHD) and stroke in older adults. The main objective is to identify factors related to the onset and course of heart disease and stroke. Subjects were recruited (as above) in 1989-90, and were followed with semi-annual contacts, alternating between telephone calls and surveillance clinic visits through 1998-99. A new cohort was recruited in 1992. The 687 participants in the new cohort are predominately African-American and were recruited at three of the four field centers.

At baseline, the mean age was 72 years and the cohort was 58% women, 16% African-American, and 31% had CVD. Participants were contacted twice per year, with phone follow-up alternating with clinic visits through 1999. Clinic exams included medical and personal history, medication inventory, ECG, blood pressure, and assessment of physical and cognitive function, depression. Other components done less frequently included phlebotomy, spirometry, echocardiography, carotid ultrasound, cranial MR, and retinal exam, Cardiovascular events were adjudicated by a committee.

After the CHS clinic exams ended in June 1999 and continuing through the present time, two phone calls per year to participants identified events and collected limited information. Grant funding from several sources has supported an additional clinic visit in 2005-2006 and continued morbidity and mortality follow-up.

For a complete list of related references, please link to the CHS bibliography page.

• Primary Phenotype: Cardiovascular Diseases
• Cerebrovascular Disorders
• Stroke
• Aging
• Atherosclerosis
• Myocardial Infarction
• Angina Pectoris
• Coronary Artery Disease
• Intermittent Claudication
• Heart Failure
• Ischemic Attack, Transient
• Diabetes Mellitus
• Kidney Failure, Chronic

• CHS Principal Investigators and Study Sites
  • http://www.chs-nhlbi.org/pi.
• Project Office
  • Jean Olson, MD, MPH*. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
• CHS Coordinating Center
  • Richard Kronmal, PhD*. University of Washington, Seattle, WA, USA.
• CHS Field Centers
  • John Robbins, MD, MHS*. University of California, Davis, Sacramento, CA, USA.
  • Linda P. Fried, MD, MPH*. Johns Hopkins University, Baltimore, MD, USA.
  • Gregory Burke, MD*. Wake Forest Unversity School of Medicine, Winston-Salem, NC, USA.
  • Lewis H. Kuller, MD, DrPH*. University of Pittsburgh, Pittsburgh, PA, USA.
• CHS Collaborating Centers
  • Russell Tracy, PhD*. Blood Laboratory, University of Vermont, Colchester, VT, USA.
  • John Gottdiener, MD. Echocardiography Reading Center, University of Maryland, Baltimore, M.
  • Ronald Prineas, MD, PhD. EPICARE Center, Wake Forest Unversity School of Medicine, Winston-Salem, NC, USA.
  • James T. Becker, PhD. MRI Archive, University of Pittsburgh, Pittsburgh, PA, USA.
  • Paul Enright, MD. Respiratory Sciences Center, University of Arizona, Tucson, AZ, USA.
  • Ronald Klein, MD. Retinal Reading Center, University of Wisconsin, Madison, WI, USA.
  • Donald H. O'Leary, MD. Ultrasound Reading Center, Tufts New England Medical Center, Boston, MA, USA.
• CHS Steering Committee
  • The CHS Steering Committee is made up of each Principal Investigator listed above with an asterisk mark (*) after the name. The Chair of the Steering Committee is Curt Furberg, MD, PhD, of Wake Forest University, Winston-Salem, NC, USA.
• Funding Sources
  • N01-HC-85079. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-85080. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-85081. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-85082. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-85083. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-85084. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-85085. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-85086. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-35129. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-15103. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-55222. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-75150. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • N01-HC-45133. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • U01-HL080295. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • HHSN268201200036C. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • HHSN268200800007C. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
  • R01-HL130014. National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.