Framiningham Heart Study

Introduction

Due to an alarming epidemic of cardiovascular disease beginning in the 1930's, the United States Public Health Service decided to undertake a large-scale study to investigate why heart disease was the nation's number one killer by the late 1940's. Researchers and doctors wanted to learn what biologic and environmental factors were responsible for the rapid rise of cardiovascular deaths and disability. They wanted to learn how and why people that developed heart disease differ from those who didn't. Searching for answers the government initiated a study called the Framingham Study. In the town of Framingham, Massachusetts, 5,209 healthy residents between 30 and 60 years old, both men and women, were selected and enrolled as the first cohort of participants. Every two to four years study participants are given extensive medical examinations to assess multiple aspects of their current health status.

This study was implemented to help our medical professionals understand major risk factors associated with developing heart, vascular disease and stroke.

History of Study

The Framingham study was initiated under the guidance of the National Heart Institute (to later become the National Heart, Lung and Blood Institute; the NHLBI) to assess genetic and familial factors in determining risk for heart disease. From its inception, the study was to be a long-term analysis of the physical and environmental factors that influence the development of heart disease. Prior to this study, it was assumed that heart disease and strokes were an unavoidable consequence of aging. Very little was known about heart disease before this study. It was never considered that a physician could predict or influence the risk factors.

The good men and women of Framingham Massachusetts, at least those involved in this study, were in supposed "good health." The first subject was examined in 1948 and within the first few years over 5,000 participants had been initiated into the study. One of the biggest challenges in conducting the study was that the behaviors and lifestyles were not consistent between individuals. Early assumptions were based first on individuals, then commonalities between them, and over time familial relationships. All aspects of a subject's daily life were tracked. Everything was monitored, from diet and nutrition, to cigarette smoking, along with all facets of their everyday life.

The whole town was selected to monitor not just individuals but also to track the impact of their physical environment as well. As a "next level" to the study, the children of Framingham became part of the study as well. This was labeled the "Offspring Study" and has evolved into even further studies of similar nature since then. Meticulous, detailed medical examinations continue to be conducted every two to four years. A third generation was brought into the study in 2002.

The study was the opening of Pandora's box! The study uncovered much more than could have been anticipated. The goal was to identify characteristics and commonalities to better diagnose heart disease. The premise was, that having the opportunity for early detection and diagnosis would save lives and lead to earlier treatment. Instead of being reactive doctors could be proactive and take preventative actions. Over time improvements in medical technology have both improved and broadened the scope of identifiable factors and the degree to which they could be measured.

Major Problems or Limitations

Although the Framingham Study did so much for healthy living, there were inevitably still some problems with the study. It did many great things for the way we think, act, and talk about how our lives are impacted by the way we eat and exercise. Some would say it was the most influential study for healthy living. While some discuss the conclusions, its authors still admit that there are problems with the study.

The first thing that can make our break a study is the validity of the information gathered for the study. That is where this study has its biggest problem. It is not the fault of the authors; it is the fault of many doctors over many years. It is the doctors' fault for misclassifying many deaths. By misclassifying the deaths the information that was gathered was inaccurate or incorrect all together. In the study of 2683 deaths, coronary heart disease was listed as the cause of death for 35%. After further review by a panel of esteemed physicians, the number was changed to 28%. That is a big discrepancy and makes the rest of the data appear questionable at best.

The first major limitation of the study came from the lack of information given to the panel. The panel was, in many situations, given cases with limited information to correctly diagnose the cause of death. In most cases during the study, the older the person was the harder it was to determine the actual cause of death due to the many possible contributing factors that age can bring. So as not to make uninformed decisions, the panel did not try to reclassify these cases.

The second limitation is one that can affect any type of research study. The group size, geographic area, and many other scopes of possible data used in the sample group is ultimately important in determining if the validity of the findings. This study uses just one community as a sample for its research. This is likely one of the biggest arguments of the validity of the study, as geographic location, income level, available resources, and much more could possibly impact the many factors considered in the findings. If the study had been done (which today is not inconceivable, but back then would have been more difficult) throughout rural and urban communities, various races, all income levels, religions, etc., the validity of the study may be less in question. Regardless, it is hard to argue the main discoveries in the study, limited sample group or not.

Major Conclusions

What started out in 1948, as the Framingham Study has become something much bigger than researchers originally predicted. It's come to be known as "The Study That Changed America's Heart." (Healthline March 14, 2007) It has evolved into what will likely continue for many years to come, if not forever. The major reason for this is because of the large amount of useful information it's produced on the topic of cardiovascular disease (CVD).

Based on results from Framingham, scientists developed the concept of "risk factors." Today, "risk factor" is a term most people are familiar with, and simply is defined as aspects of health and lifestyle