Framingham Heart Study
The Framingham Heart Study began in 1948 to systematically examine the population of a city ( Framingham , Massachusetts ) for the causes and risks of coronary artery disease (CHD) and arteriosclerosis . In the 1940s, the United States Public Health Service (PHS) wanted to know why CAD is the leading cause of death in the United States and what risk factors and environmental factors are driving the rise in diseases such as heart attacks and strokes . The cohort study was chosen as an epidemiological approach. In order to find out connections between exposure and diseases, those study participants were selected as part of the study design who had not previously exhibited the diseases to be examined. First 5209 participants were between the 30th and 60th year of life gained both sexes for the study. In 1971 the children of the first test subjects were included, so that the study extended over two generations ; meanwhile (2016) it is in the third generation.
The participants from the city were assigned to different exposures, for example smoking or excessive alcohol consumption . It was then checked whether persons with exposure are more ill than those without exposure. The important thing about such a study is that the study population must be available at a later point in time. Only then can it be determined and compared. Important statements about cardiovascular risk factors could be made from the results of the study. Even today, the Framingham Heart Study is still the most important epidemiological study in the United States.
The results of this study are now standard medical practice. Considered risk factors for cardiovascular disease
- high cholesterol ,
- increased blood pressure
- and high blood sugar (see Tables 2 and 3 in the article on heart failure )
recognized and comprehensively described.
Before the Framingham study, lowering blood pressure, especially in women and the elderly, wasn't taken seriously enough. Only after analyzing the data did it become clear that high blood pressure also increases the risk in these groups. The intervention studies VACS, PHSCS and VA-NHLBI, which began in the mid-1960s, then had to show whether and to what level the blood pressure actually had to be effectively lowered in these patients in order to avoid secondary diseases . As an epidemiological study, the Framingham study could only prove the risk association, but not the benefit of a treatment.
The Framingham study also examined the American lifestyle and identified factors that favor heart disease or a stroke: cigarette smoking, sedentary lifestyle , weight gain, malnutrition. More than 3,000 scientific publications were published in connection with the Framingham Heart Study (as of May 2020).
The extensive cross-generational data on social networks and relationships obtained in the study are now also used for studies that deviate from the original research purpose. In 2008, for example, they were linked to the General Depression Scale (ADD) as part of a long-term study of the dynamic spread of happiness , which found that happiness is a collective and contagious phenomenon.
List of the most important results
|1948||Start of the study|
|1956||First report on rheumatic heart disease|
|1959||First report on heart disease risk factors ; Report on "silent" heart attacks|
|1960||Cigarette smoke described as a risk factor|
|1961||Cholesterol level , blood pressure and EKG changes as risk factors|
|1965||First report of stroke|
|1967||Sports activities lower the risk of the disease, obesity increases it|
|1971||Start of the investigation of the next generation|
|1974||Overview of diabetes mellitus , its secondary diseases and as a risk factor for heart disease|
|1976||The menopause is identified as a risk factor|
|1977||The influence of HDL , LDL and triglycerides (see blood lipids ) on heart disease is described|
|1978||Influence of psychosocial factors; Atrial fibrillation as a risk of stroke|
|1981||Filter cigarettes do not provide protection; Relationship of diet and heart disease|
|1983||Report on the mitral valve prolapse|
|1986||First report on dementia|
|1987||Danger from high cholesterol and fibrinogen levels|
|1988||Cigarette smoking as a risk factor for stroke|
|1990||Homocysteine is described as a risk factor for heart disease|
|1993||Mild high blood pressure is also a risk factor|
|1994||Risk factors for atrial fibrillation; the enlarged left ventricle as a risk factor for a stroke|
|1996||Progressive high blood pressure can lead to heart failure lead|
|1997||Report of the cumulative effects of smoking and high cholesterol on arteriosclerosis|
|2002||Obesity increases the risk of heart failure. The study showed that body mass index (BMI) is an independent risk factor.|
|2002||The third generation with 3,900 people was started. Central goals include the identification of new risk factors for heart, lung and blood diseases as well as genes that guarantee health .|
|2004||A parent with a history of cardiovascular disease doubles their personal risk of developing it.|
|2005||The risk of heart attack, stroke, or peripheral arterial disease (PAD) is 45% higher in middle-aged people and with siblings who have similar cardiovascular disease .|
- Syed S. Mahmood, MD, Prof. Daniel Levy, MD, Prof. Ramachandran S. Vasan, MD, Prof. Thomas J. Wang, MD: The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. The Lancet, March 15, 2014, accessed November 28, 2016 .
- Leon Gordis: Epidemiology. Fourth edition. Sauders Elsevier, Philadelphia 2009
- Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg . In: JAMA: The Journal of the American Medical Association . tape 202 , no. 11 , December 11, 1967, ISSN 0098-7484 , p. 1028-1034 , doi : 10.1001 / jama.202.11.1028 .
- Low-dose captopril for the treatment of mild to moderate hypertension. I. Results of a 14-week trial. Veterans Administration Cooperative Study Group on Antihypertensive Agents . In: Archives of Internal Medicine . tape 144 , no. 10 , October 1, 1984, ISSN 0003-9926 , p. 1947–1953 , doi : 10.1001 / archinte.144.10.1947 .
- H. Mitchell Neurath, Anne I. Goldman, Mary Ann Lavin, Harold W. Schnaper, Annette E. Fitz: EVALUATION OF DRUG TREATMENT IN MILD HYPERTENSION: VA-NHLBI FEASIBILITY TRIAL. Plan and Preliminary Results of a Two-Year Feasibility Trial for a Multicenter Intervention Study to Evaluate the Benefits versus the Disadvantages of Treating Mild Hypertension: Prepared for the Veterans Administration-National Heart, Lung, and Blood Institute Study Group for Evaluating Treatment in Mild Hypertension ? In: Annals of the New York Academy of Sciences . tape 304 , 1 Mild Hyperten, March 1978, ISSN 0077-8923 , p. 267-287 , doi : 10.1111 / j.1749-6632.1978.tb25604.x .
- J. H Fowler, N. A Christakis: Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study . In: BMJ . tape 337 , 2008, p. a2338 , doi : 10.1136 / bmj.a2338 .