Boston University Medical Campus
Medicine

Research Activities
The Section of Preventive Medicine and Epidemiology is involved in applied epidemiology in the fields of cardiovascular disease, cancer, and the problems of aging, including Alzheimer’s disease. One of the major research sources is the Framingham Study, organized in 1948 by a former Section head, Thomas R. Dawber, M.D. His successor, William B. Kannel, M.D., who served as chief of the Section from 1978 to 1989, has been widely recognized for his continuing work in the study, and has received many international awards for his contributions to preventive cardiology. R. Curtis Ellison, M.D., M.S., Chief of the Section since 1989, and Professor of Medicine and Public Health, focuses his research primarily on environmental and genetic factors that relate to hypertension and coronary heart disease; the relationship between moderate alcohol consumption and chronic diseases; and the development, early in childhood, of dietary and physical activity habits that relate to obesity and other adult cardiovascular risk factors.

The Section collaborates with the National Institutes of Health (NIH) in studies of cataracts, macular degeneration, glaucoma and retinopathy, as well as in studies of pulmonary disease, cancer, and osteoarthritis. The Section also directs the Framingham Children’s Study, a study of third- and fourth-generation descendents of families involved in the Framingham Study. In addition, the Section collaborates with other medical centers in the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study; the HyperGEN Family Blood Pressure Project; and the Family Heart Study SCAN project that involves the evaluation of genetic and environmental factors associated, respectively, with coronary disease, hypertension, and coronary artery calcification.

Section members include Philip A. Wolf, M.D., neurologist and epidemiologist, Professor of Neurology and Public Health, and principal investigator of the NHLBI contract supporting the Framingham Study and NIH?supported research studies of stroke and dementia in Framingham.

Kenneth J. Rothman, Dr.PH., Professor of Public Health, is one of the world’s leading epidemiologists, teachers, and textbook authors. He is a founding editor of the journal Epidemiology and a consultant for many studies at institutions around the world.

Lynn L. Moore, D.Sc., Associate Professor of Medicine, directs the Framingham Children’s Study, which has shown how lifestyle factors starting early in life relate to the development of obesity during childhood and later cardiovascular risk. Much of Dr. Moore’s recent research has dealt with key analytic questions related to obesity and diabetes: the effect of obesity and diabetes, including gestational diabetes, on pregnancy outcome; effects of sustained and non-sustained weight loss on the risk of adult-onset diabetes, hypertension, and cardiovascular disease; effects of weight and weight gain on cancer risk (colon, breast, prostate, lung); the causes and consequences of obesity in childhood; and the effects of anemia on the risk of heart failure and cardiovascular disease.

Yuqing Zhang, M.D., D.Sc., Associate Professor of Medicine and Public Health, studies the epidemiology of cancer, arthritis, osteoporosis, moderate alcohol consumption, cardiovascular disease, and cognitive function.

Luc Djoussé, M.D., D.Sc., Assistant Professor of Medicine, researches the epidemiology of moderate alcohol consumption, cardiovascular disease, cancer, endocrine diseases, and is becoming involved in genetic epidemiology. Determinants of cardiovascular disease and Huntington disease continue to be the focus of Dr. Djoussé’s research. The principal analytic questions that he has been addressing regarding cardiovascular disease deal with the relationship between dietary linolenic acid and risk of myocardial infarction; the relationship between smoking, alcohol consumption, and apolipoprotein E allele E4 and early atherosclerosis as measured by intima media thickness; and dietary fat intake, fruits, and vegetables consumption and serum cholesterol. In addition, Dr. Djoussé has contributed to the relationship between birth weight and risk of hypertension and myocardial infarction. He has also offered insight concerning Huntington’s disease and the interaction between normal and expanded CAG repeats that affect age at disease onset; HOX7 gene as a potential linked modifier of age at onset; and weight loss in early stages of the disease.

Munro H. Proctor, M.D., M.P.H., Associate Professor of Medicine, studies international health, especially in Cameroon where he directs a number of projects. His work focuses on microenterprise development for women, verbal autopsy methodology, assessment of chronic disease risk factors, and AIDS.

Other senior members associated with the Framingham Study include Daniel Levy, M.D., current NIH Director of the Framingham Study and Associate Professor of Medicine; William B. Kannel, M.D.; Peter Wilson, M.D., Professor of Medicine; Christopher O’Donnell, M.D., Assistant Professor of Medicine at Harvard Medical School; Donald Lloyd-Jones, M.D., Assistant Professor of Medicine; and Vasan Ramachandran, M.D., Associate Professor of Medicine.

Section members also include Richard Meyers, Ph.D., Professor of Neurology, and Lindsay Farrer, Ph.D., chief of the Genetics Unit, and Professor of Medicine, who spearhead research in genetic epidemiology; and Pantel Vokonas, M.D., Professor of Medicine, who directs the Veterans Administration’s Normative Aging Study.

Education
While all Section faculty are involved in the teaching of students and house staff, they also work collaboratively with other Boston University faculty, offering expertise and experience in study design and analysis to investigators in their clinical and epidemiological research. The specific types of assistance available may fall into one or more of the following categories:

• Study conceptualization, design, and organization
• The development of appropriate forms for collecting and organizing clinical data
• Data entry, management, and quality control
• The outline of plans for data analysis and interpretation of results
• Mentoring of students, house staff, or junior faculty in research undertakings

The Section’s formal teaching activities include primary responsibility for the course in cardiovascular epidemiology (Dr. Ellison) and an advanced epidemiological methods course (Dr. Rothman) in the Boston University School of Public Health (SPH). Dr. Zhang is a lecturer in several courses, and Drs. Moore and Djoussé also lecture. The Section assists Jane Liebschutz, M.D., Assistant Professor of Medicine, in directing the Preventive Medicine Residency at Boston Medical Center. Most of the faculty serve as committee chairs or advisors for master’s and doctoral students at the Boston University School of Public Health.

Major Accomplishments
Dr. Ellison recently released a key paper that has helped reduce concern about a possible relationship between moderate drinking and breast cancer in women (“Exploring the relation of alcohol consumption to risk of breast cancer,” American Journal of Epidemiology). The article reviewed all articles published on the topic, and demonstrated that among the more scientifically sound, recent research reports from the United States, the risk of breast cancer among moderate drinkers was only minimally increased. Further, the authors commented on other recent research showing that there is no increase in breast cancer risk among moderate drinkers who maintain an adequate intake of folate.

Dr. Ellison also published an article on duration of life for drinkers versus non-drinkers (“The “bottom line” — Do moderate wine drinkers live longer?” Bulletin O.I.V.) He concluded that moderate drinkers do live longer than abstainers, and also have lower risk of congestive heart failure (“Alcohol consumption and risk of congestive heart failure in the Framingham Heart Study,” Annals of Internal Medicine). Other recent publications from the NHLBI Family Heart Study have shown how a variety of factors (especially dietary and other lifestyle factors) relate to the risk of coronary heart disease.

Since 1994, Dr. Ellison has directed the Institute on Lifestyle and Health at Boston University School of Medicine. The institute focuses research on various aspects of lifestyle, especially diet, exercise, and the moderate consumption of wine and other alcoholic beverages, habits that relate to the risk of heart disease, cancer, and other chronic diseases. In 2002, Dr. Ellison received the New York Wine & Grape Foundation’s annual research award for his research related to wine and health. He also received the Premio Giacomo Bologna for “research contributing to the quality of life” from the Bologna Foundation, Rocchetta Tanaro, Italy. Dr. Ellison is a member of the Editorial Board of AIM (Alcohol in Moderation), United Kingdom, and is chairman of the Advisory Board of the Elizabeth Bishop Wine Resource Center, Boston University.

Dr. Djoussé has a number of key publications on a variety of factors associated with cardiovascular disease. He and other Section members have recently completed a project on alocohol and the risk of ischemic stroke (“Alcohol consumption and risk of ischemic stroke: The Framingham Study,” Stroke). These analyses showed considerable protection against stroke for moderate drinkers in the 60- to 69-year age range, but no evidence for protection for older subjects; the reasons for these differences according to age are currently unclear. Others have found protection against ischemic stroke at all ages.

Dr. Moore was awarded the 2001 Roche-ISPE Epidemiology Prize, given annually by the editorial board of Epidemiology for an outstanding original research. The award was presented for the paper titled, “Can sustained weight loss in overweight individuals reduce the risk of diabetes mellitus?

Dr. Proctor remains very active in international health projects, in particular, improving the health care of women in Cameroon. He directs numerous projects there, including improved detection and prevention of AIDS and tuberculosis, as well as microenterprise endeavors that permit very poor Cameroon women self-sufficiency. Dr. Proctor recently demonstrated the ability to obtain valuable medical data from “verbal autopsies” obtained by health care workers in developing countries.

Dr. Rothman continues to make major contributions to the scientific literature related to reproductive epidemiology; the epidemiology of the relationship between birth characteristics and adult disease; and environmental epidemiology, including research on the health effects of cellular telephones. He has written a textbook, Epidemiology — An Introduction, recently published by Oxford University Press, that is intended for medical students and others taking a first course in epidemiology. He is also involved in work on ethical issues relating to public health and medical research. Dr. Rothman continues to be a sought-after teacher in epidemiology seminars and courses internationally.

As principal investigator for the NHLBI contract supporting the Framingham Study and for a number of other key NIH grants, Dr. Wolf continues to make important contributions to the epidemiology of heart disease, stroke, and other chronic conditions. In the last year, he and other leading investigators in the Framingham Study have reported on the many factors related to coronary heart disease (left ventricular mass and heart disease; depression and heart disease); stroke (effects of stroke on mortality; potassium intake and stroke; c-reactive protein and stroke; hypertension and stroke prevention); and cognitive function and Alzheimer’s disease (brain volume and cognitive function; effects of homocysteine and serum cholesterol on risk of Alzheimer’s disease); and other chronic diseases.

Within the past two years, Dr. Wolf has been awarded the American Heart Association’s C. Miller Fisher, M.D., Award; named a Fellow of the Council on Epidemiology, Stroke Council; and selected for Who’s Who in America.

Through his research, Dr. Zhang has demonstrated, for the first time, how bone-mineral density, considered the best measure of cumulative estrogen exposure, leads to an increased risk of breast cancer (“Bone mineral density and breast cancer,” New England Journal of Medicine) and to a reduced risk of both verbal memory impairment (“Bone mineral density and verbal memory impairment,” American Journal of Epidemiology) and the risk of colon cancer (“Bone mass and the risk of colon cancer among post-menopausal women: The Framingham Study,” American Journal of Epidemiology). Other research accomplishments with which Dr. Zhang is credited include the relationship of bone mass to prostate cancer risk, alcohol consumption and cognitive function in NHANES III and the prevalence of symptomatic hand osteoarthritis and its impact on function in the Framingham Study. Dr. Zhang is the principal investigator of a study of risk factors triggering acute gout attacks using an Internet-based case-crossover study design.