The Framingham Heart Study:

Cholesterol Management Might Still
Be In the Dark Ages Without It

A word about the Framingham Heart Study is critical to any discussion of cholesterol management or coronary heart disease.

If you spend any time at all reading medical journals or papers concerned with cholesterol management you will have heard of the Framingham Heart Study. It may be a bit dramatic to say that before the beginning of this study our knowledge of heart disease was in the dark ages. On the other hand it is difficult to overemphasize its importance in advancing medical science in the fight against one of our most deadly enemies.

Benefits of the Framingham Heart Study

Did you know that before the Framingham Heart Study most physicians believed that atherosclerosis (clogging of the arteries) was an inevitable part of aging? I didn’t either.

It was therefore assumed that as a person aged his blood pressure naturally went up in order to force the blood through the narrowing arteries. In fact it was widely assumed that the elderly tolerated high blood pressure well.

Doctors also did not identify risk factors that could lead to heart disease and therefore had little sense of prevention. For example serum cholesterol was not widely considered a factor in the development of cardiovascular disease.

Therefore people made no efforts to reduce cholesterol. Nor was there any understood connection between LDL cholesterol management and coronary heart disease.

Other heart health related factors have been discovered through the Framingham Heart Study. Cigarette smoking was not previously considered a factor in the development of heart disease. Through the study we have come to know that smoking cigarettes increases a patient’s risk of myocardial infarction (heart attack) and sudden cardiac death (a sudden arrhythmia leading to heart stoppage).

We have also become aware that poor diet, weight gain and lack of exercise make one more likely to experience heart trouble.

Our previous ignorance, of course, contributed greatly to the cardiovascular disease epidemic that we see as far back as the 1930’s. In 1948 the United States Public Health Service undertook a large-scale study designed to investigate this increase in heart disease.

It was rightly assumed that negative changes in heart health of this magnitude must be tied to biological and environmental factors. It was noted that certain people are plagued with heart disease while others seem relatively unaffected. Identifying the distinguishing factors between these two types of people provide insight into how to fight heart disease.


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Are there health issues – in addition to your heart health – that concern you? Like…

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  • And poor nutrition?
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The Framingham Heart Study Design

The study was designed to follow trends in heart health and heart disease through multiple generations.

And so, more than a half century ago, in the town of Framingham, Massachusetts this landmark study began. The first group of patients included 5,209 healthy men and women between the ages of 30 and 60. The National Heart Institute - now the National Heart, Lung, and Blood Institute - assumed the responsibility for guiding the study. Researchers from the Boston University School of Medicine have since played a vital role in the study.

To increase our understanding of genetic roles in heart disease a second generation of patients was added to the first group in 1971. The study recruited 5,124 offspring, including spouses, from the original group. Recently a third generation has been gathered involving 3,500 grandchildren of the original cohort.

Because the original Framingham Heart Study was restricted to white participants, questions of its applicability to other races have been raised. Therefore the Omni Study was recently started involving 500 of Framingham’s minority members.

Each participant in the study is given an extensive medical exam every two to four years. The exam includes…

  • medical history
  • a blood test
  • a bone scan
  • an echocardiogram
  • an eye exam
  • various other tests

This detailed gathering of statistics is used by researchers to identify trends and major risk factors for cardiovascular disease.

General Results

As mentioned before, many heart health factors such as cholesterol, blood pressure and diabetes were previously considered immaterial to heart disease. The Framingham Heart Study has since made us aware that…

  • high total cholesterol
  • high triglycerides
  • high LDL cholesterol
  • low HDL cholesterol…

…are conducive to the development of cardiovascular disease. This may be old hat to you and me but it was virgin territory at the beginning of the study. We now know that middle aged men are not the only ones who are negatively affected by high blood pressure. The elderly in general, and women in particular, with high blood pressure are also at higher risk for developing heart disease.

Lifestyle choices now are considered of extreme importance for the maintenance of heart health. Diets high in saturated fats and, especially, trans-fats are known to promote heart disease. And though many people do not want to acknowledge it, cigarette smoking increases one’s risk for heart attack and sudden death.

In fact for those who stop smoking, it has been found their risk for heart disease is roughly half the risk of someone who continues to smoke. Since the Framingham Heart Study began more emphasis has been placed on weight reduction and exercise as a preventive for cardiovascular disease.

In addition to heart issues the Framingham Heart Study has pioneered new areas of research. Because of the extensive collection of data new work is being performed concerning…

  • cancer
  • dementia
  • osteoporosis
  • arthritis
  • hearing disorders
  • eye problems

Well over 1,000 articles have appeared in leading medical journals as a result of this study.

Predicting High Cholesterol Risk with a Score Card

Researchers with the Framingham Heart Study have developed a score sheet that can help doctors predict cardiac events. By cataloguing the number of risk factors a patient has, the doctor can predict the likelihood of...

... from heart disease within the next ten years. Such predictions can more enable the doctor and patient to pursue curative and preventive measures. By controlling and reducing the risk factors a patient can reduce the likelihood of a cardiac event thereby extending his life and improving the quality of that life.

The prediction score sheet involves a nine step process whereby the doctor assesses the patient by a series of risk factors including…

Each factor has points associated with it. When all the points are added together the patient receives an overall score. This score is compared to a chart that predicts the patient’s likelihood of developing coronary heart disease or experiencing a coronary event within the next ten years.

Current Studies in Other Risk Factors

In addition to the risk factors used on the score card the Framingham researchers are investigating other factors that can affect heart health.

High levels of homocysteine (an amino acid) may contribute to the development of…

  • Heart disease
  • Stroke
  • Reduced blood flow in the feet and hands

It is further believed that homocysteine may contribute to the buildup of fatty substances in the arteries, make the arteries themselves less flexible and cause the blood platelets to become increasingly 'sticky'.

Lp(a), like LDL cholesterol, is a lipoprotein thought to be a risk factor for early heart disease. Unlike LDL, Lp(a) does not promote fatty buildup in the arteries. Rather it is believed to prevent the breakup of clots.

Viruses and other infectious agents may harm blood vessels thus promoting atherosclerosis (clogging of the arteries). Research continues with infectious agents known to cause physical problems elsewhere to determine if they also promote heart disease.

What Have We Gained?

In short the Framingham Heart Study has produced many major discoveries that have helped researchers and scientists predict, treat and prevent the development of heart disease. It has also opened doors to research concerning other serious health conditions formerly thought unrelated to heart health. It has been the foundation for other research and continues to be the common point of reference for much of the progress that strives to make us a healthier people.

But the discoveries are not only for researchers. We have learned that, in many cases, we are responsible for our own heart health. Heart disease does not just come upon us like a thief in the night. It is most often a product of our lifestyle choices. We are in the driver’s seat much more than we previously thought.

To see more on how cholesterol management affects heart health, return to the Cholesterol Main Page and follow the links that interest you. 

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