Few medical investigations have had the impact of the Framingham Heart Study. This study, started in 1948, was designed as a cohort, observational study of cardiovascular disease, then recognized as a growing health threat but now has emerged as much more. The Framingham Heart study came to revolutionize thinking about cardiovascular disease, change the study of epidemiology, and even force the biostatistics community to develop multivariate analysis. In a special issue of Progress in Cardiovascular Diseases, leaders from around the world offer their views on the global impact of the Framingham Heart Study.
The issue includes 10 articles describing not only the historical background of the Framingham Study, but also some of the current public health programs around the world that grew out of Framingham. An interview with Dr. William Kannel, one of the principal investigators, provides a personal perspective on this monumental work.
From the insights developed over the 60+ years of this still-ongoing study, significant investigations show the continuing influence of Framingham. Dr. Pekka Puska describes the Finnish-North Karelia project, the most potent demonstration that behavioral alteration in lifestyle risk factors leads to improved cardiovascular outcomes. Dr. K. Srinath Reddy describes a wide-reaching public health initiative to combat an explosive emergence of cardiovascular disease in India and Southeast Asia. In another program based on the legacy of Framingham, Drs. Cother Hajat and Oliver Harrison describe their comprehensive survey of over 95% of the Abu Dhabi population to develop a nation-wide prevention program for both the native citizens and the immigrant communities.
"The now well-established risk factor concept, fundamental to prevention of CVD, originated from the Framingham study," commented Shanthi Mendis, MD, of the World Health Organization. "It generated seminal findings such as the effects of tobacco use, unhealthy diet, physical inactivity, obesity, raised blood cholesterol, raised blood pressure, and diabetes on CVD. When these findings were first published, these were novel cardiovascular risk factors, now they are the major focus for global and national prevention efforts for reducing the burden of CVD and other major noncommunicable diseases. The Framingham Heart Study has also been in the forefront of the development of cardiovascular risk prediction equations for assessment of absolute risk."
The true global impact of the Framingham Heart Study, according to Henry Greenberg, MD, St. Luke's Roosevelt Hospital Center, New York, NY, and Editor-in-Chief of Progress in Cardiovascular Diseases, is whether prevention works. "The final verdict on the efficacy and relevance of the Framingham Heart Study is the outcome. Altering behavioral or cultural or political determinants of risk does reduce the societal burden of CVD. In the United States, though lacking a top-down approach to public health, the dramatic fall in CVD mortality in the early 1960s when little but blood pressure control was available speaks to this. During the ensuing 40 years, about half of the 50% fall in CVD mortality is attributable to prevention and risk factor modification, the legacy of the Framingham Heart Study."
These articles appear in a special issue of Progress in Cardiovascular Diseases, The Global Impact of the Framingham Heart Study, Volume 53, Number 1, (July/August 2010), published by Elsevier.
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