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Cardiovascular disease (CVD) is the leading cause of death and serious illness in the United States. In 1948, the Framingham Heart Study -- under the direction of the National Heart Institute (now known as the National Heart, Lung, and Blood Institute; NHLBI) -- embarked on an ambitious project in health research. At the time, little was known about the general causes of heart disease and stroke, but the death rates for CVD had been increasing steadily since the beginning of the century and had become an American epidemic. Since 1971, the Framingham Heart Study has been conducted in collaboration with Boston University.

The objective of the Framingham Heart Study was to identify the common factors or characteristics that contribute to CVD by following its development over a long period of time in a large group of participants who had not yet developed overt symptoms of CVD or suffered a heart attack or stroke.

Original Cohort

    

The researchers recruited 5,209 men and women between the ages of 30 and 62 from the town of Framingham, Massachusetts, (Table 1) and began the first round of extensive physical examinations and lifestyle interviews that they would later analyze for common patterns related to CVD development. Since 1948, the subjects have continued to return to the study every two years for a detailed medical history, physical examination, and laboratory tests.

Offspring Cohort

    

In 1971, the study enrolled a second-generation group -- 5,124 of the original participants' adult children and their spouses -- to participate in similar examinations (Table 2).

Generation III Cohort

    

A Third Generation (the children of the Offspring Cohort) is currently being recruited and examined, seeking to further understand how genetic factors relate to cardiovascular disease. These participants are being given an extensive cardiovascular examination similar to their parents and grandparents. The goal is to recruit and examine 3,500 grandchildren of the original cohort.

    


Over the years, careful monitoring of the Framingham Study population has led to the identification of the major CVD risk factors -- high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity -- as well as a great deal of valuable information on the effects of related factors such as blood triglyceride and HDL cholesterol levels, age, gender, and psychosocial issues. Although the Framingham cohort is primarily white, the importance of the major CVD risk factors identified in this group have been shown in other studies to apply almost universally among racial and ethnic groups, even though the patterns of distribution may vary from group to group. Since its inception, the study has produced approximately 1,200 articles in leading medical journals. The concept of CVD risk factors has become an integral part of the modern medical curriculum and has led to the development of effective treatment and preventive strategies in clinical practice.

The Framingham Heart Study continues to make important scientific contributions by enhancing its research capabilities and capitalizing on its inherent resources. New diagnostic technologies, such as echocardiography (an ultrasound examination of the heart), carotid artery ultrasound, bone densitometry (for monitoring osteoporosis), and computerized tomography of the coronary arteries, are evaluated and integrated into ongoing protocols.

While pursuing the study's established research goals, the NHLBI and the Framingham investigators are expanding their research into other areas such as the role of genetic factors in CVD. Framingham investigators also collaborate with leading researchers from around the country and throughout the world on projects in stroke and dementia, osteoporosis and arthritis, nutrition, diabetes, eye diseases, hearing disorders, lung diseases, and genetic patterns of common diseases.

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