Framingham Heart Study

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In 1951, Evelyn DiLauro received what she today calls, “the opportunity of a lifetime.” She was asked to join the Framingham Heart Study—a study that, in the decades that followed, would revolutionize health care in America. Mrs. DiLauro was in the original group of approximately 5,000 Framingham residents who agreed to share their health histories, with comprehensive examinations every two years. Twenty years later, her two children would join the project’s “Offspring Study,” and twenty years after that, her four grandchildren would join the third generation program.

“I would never miss my appointments,” says Mrs. DiLauro, who is now 98 years old and still goes for regular examinations. When asked why, she replies, “Anything concerning the heart is pretty important.”

In the annals of medicine, few research initiatives have had as great an impact as the Framingham Heart Study, managed by the Boston University School of Medicine for the past 40 years. The study’s insights transformed the medical profession’s approach to cardiovascular health and launched a new field of preventive medicine.

“Framingham changed the focus of health care from treating sick people to trying to prevent healthy people from getting sick,” says Dr. Philip A. Wolf, the study’s principal investigator.

Because of the Framingham Heart Study, we know that smoking, high cholesterol, and obesity increase the risk of cardiovascular disease and that physical activity lowers the risk. The study also identified diabetes and high blood pressure as risk factors for heart disease. Indeed, the term “risk factor” itself was coined by the Framingham Heart Study.

Dynamic direction

“This is not your grandfather’s heart study,” Dr. Wolf says. “We have remained at the forefront because we have stayed on the leading edge of the technology.”

When the study began over six decades ago, researchers recorded blood pressure, electrocardiograms, and blood chemistry. They asked participants whether they smoked, how much they exercised, and what they ate. Today, participants also are given CT scans, bone density tests, and brain MRIs. Some receive sleep studies.

Since the 1980s, the Framingham Heart Study has collected and analyzed genetic information about participants. Researchers use this data, along with individual health histories, to understand the interaction of genetics and other factors. This research has helped to advance the goal of personalized medicine, which may soon deliver customized treatment and prevention based on an individual’s genetic makeup.

With three generations now a part of the study and increasingly detailed information gathered about participants, the Framingham Heart Study is identifying risk factors not only for cardiovascular disease but also for dementia, cancer, arthritis, osteoporosis, and hearing and eye disorders.

“Some people study disease by looking through a microscope,” Dr. Wolf says. “We look through a telescope.”

A legacy of leadership

In the 1940s, heart disease was an epidemic in the United States, and experts did not know why. Seeking answers, the US Public Health Service decided to launch a long-term study. The town of Framingham, close to Boston hospitals and the site of an earlier public health study, was chosen for the project.

The National Heart Institute recruited 5,209 healthy adults—two-thirds of the town’s adult population. There were roughly equal numbers of men and women in the project, making it one of the first large health studies in the United States to include women.

By following the health of many people over a long period, the study reached important conclusions. In the first two decades, researchers discovered that high blood pressure and high cholesterol were linked to heart disease. Many of the effects of cigarette smoking, physical activity, and obesity also were identified during this period.

Boston University at the helm

Because of steep budget cuts in the late 1960s, the federal government moved to close the Framingham Heart Study. But Dr. Thomas R. Dawber, chair of preventive medicine at Boston University Medical School and the first director of the study, kept the program alive by raising private money. In 1971, the government reversed its stance and awarded Boston University medical school an exclusive contract to run the program. That same year, the Offspring Study began.

In 1994, recognizing Framingham’s growing racial diversity, the Heart Study launched the Omni Study, which follows the health histories of approximately 500 adults from the town’s minority population. The third generation of the original group was enlisted in 2002, and a second generation of the Omni group was recruited in 2003.

The Framingham Heart Study has produced more than 1,500 academic papers. It has about 100 employees, as well as visiting researchers from around the world.

Community contribution

None of the advances in cardiovascular health achieved by the study could have happened without the participation of the people of Framingham, a place that now proudly identifies itself as, “The Town that Changed America’s Heart.”

Many of the town’s civic and business leaders have been both participants and boosters—for example, the volunteer Friends of the Framingham Heart Study is a liaison between the study and the community.

The study has also enjoyed a close relationship with the town’s medical community. Local physicians have co-authored papers with the study’s researchers, and, although the study does not treat patients, when matters of concern are found in examinations, participants are alerted and encouraged to seek medical attention.

The Framingham Heart Study strives to make its examinations convenient. To reach participants who have moved, staff members travel around the country; they go to hospitals and nursing homes. Because out-of-town participants sometimes return for holidays, the Heart Study is typically open on holidays. “This is a medical office where the doctors wait for the patients,” Wolf says.

Making a Difference

The basic research of the Framingham Heart Study has been supported over the years by major federal grants and individual donors. Additional private support will keep the study at the leading edge of discovery by bringing top researchers from around the world to Framingham, broadening the project’s scope, and further expanding the horizons of medical science.

Sample giving opportunities

  • Create and name an endowed professorship for the faculty of the program: $1.25 million for an assistant professor, $2.5 million for a full professor
  • Endow a research fund: $100,000
  • Endow a scholarship for a BUSM student: $100,000
  • Endow a postdoctoral fellowship: $100,000
  • Create a current-use fellowship award: $10,000
  • Provide unrestricted support as a member of the BUSM Dean’s Club: $1,500 and above