Milestones in Framingham

The milestones of the Framingham Heart Study, which broke ground in heart disease research, just keep coming.

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1948

Researchers begin recruiting for a 20-year study of heart disease in one population: the residents of Framingham, Mass. The American Anytown of 28,000 seems a natural choice. It’s close to Boston’s preeminent cardiologists and has a solid manufacturing base offering enough jobs to keep people from leaving the area—and abandoning the study.

1949

A year after the study opens on Oct. 11, 1948, more than 2,000 residents have had physical exams and 1,000 more have appointments.

1951

The Framingham Heart Study (FHS) publishes the first of more than 2,000 peer-reviewed studies. The topic: the epidemiological approach to studying heart disease.

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1957 Framingham finds that the risk of heart disease rises as hypertension and high cholesterol levels increase.

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1957 In a startling turn, FHS finds that women between ages 30 and 62 experience angina. Women were originally recruited to determine why they were “immune” to heart disease.

1958

FHS discovers that a quarter of all heart attacks cause no pain and that nearly 40% of diabetics experience such heart attacks.

1961

FHS director Roy Dawber and then–associate director William Kannel coin the term factors of risk in a paper on the etiology of coronary heart disease.

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1962 Cigarette smoking is found to increase the risk of a fatal heart attack by fivefold. Five years later the surgeon general issues a report linking smoking to heart disease.

1967

Despite FHS findings published a decade earlier, medical textbooks still advise against the treatment of asymptomatic hypertension.

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1967 Physical activity is shown to reduce (not abet), as was thought the risk of heart disease.

1969

The National Institutes of Health (NIH) announces that FHS will shut down because of a funding shortage. Dawber resigns to raise funds. Framingham residents donate more than $40,000, and the public floods Congress with letters of protest. Paul Dudley White, who had been Dwight Eisenhower’s cardiologist, writes to President Richard Nixon, pointing out that Framingham’s budget is minuscule compared with what the government is spending on space exploration. Nixon responds that FHS will continue, but not under the direction of NIH’s Heart Institute. Dawber, now a professor at Boston University, orchestrates a partnership between NIH and the university.

1971

The Framingham Offspring Study begins recruiting 5,124 children of the original participants.

1974

Diabetes is found to double the risk of large-artery disease and to heighten risks of peripheral vascular disease and amputation.

Taylor S. Kennedy/Getty Images

1977 The Senate Select Committee on Nutrition and Human Needs advises Americans to eat less meat, eggs and dairy products—in contrast to the U.S. Department of Agriculture, which promotes those foods.

1983

FHS identifies obesity as an independent risk factor in heart disease.

1985

FHS finds that hormone-replacement therapy in postmenopausal women elevates the risk of cardiovascular morbidity more than 50% and the risk of heart attack more than twofold. It is the only one of 16 studies to show that such therapy has an adverse effect rather than a protective one.

1987 The first statin, called lovastatin, becomes available for treatment of high cholesterol. Until 1979, doctors considered everyone with a total cholesterol below 300 normal. Yet FHS data showed that 35% of heart attacks occurred in people who had a total cholesterol of just 150 to 200.

Lisa Cassidy/Metrowest Daily News

1990 FHS begins collecting the DNA of participants.

1995

Framingham’s Omni Study of minorities, exploring links between race and heart disease, begins recruitment and examinations.

1998

FHS publishes a formula for predicting, based on risk factors, a person’s chance of developing heart disease within a decade.

2000

Participants threaten to boycott the study when Boston University proposes a project in which BU would team with venture capitalists to sell a database of participants’ DNA. BU backs down.

Christina Caturano

2002 FHS begins the Third Generation study, recruiting 4,095 grandchildren of the original Framingham volunteers.

2007

FHS conducts a genomewide association study on 9,300 participants in three generations, looking for links between genes and disease. The study launches NIH’s SHARe Project, intending to create one of the most extensive databases of genetic and clinical data to be made widely available to researchers worldwide.