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  • A Change of Heart: How the Framingham Heart Study Helped Unravel the Mysteries of Cardiovascular Disease
  • Ross M. Mullner
Daniel Levy and Susan Brink. A Change of Heart: How the Framingham Heart Study Helped Unravel the Mysteries of Cardiovascular Disease. New York, Alfred A. Knopf, 2005. ix, 268 pp., illus. $26.95.

The Framingham Heart Study is one of the most important studies of modern medicine. Results from the Framingham study have been widely published in hundreds of medical, public health, and scientific journals and reports. One of the study's most important findings has been the identification of the major risk factors of coronary heart disease: hypertension, high levels of serum cholesterol, diabetes, smoking, obesity, and a sedentary lifestyle. Because of the study, the risk factors behind heart disease are now common knowledge among health professionals and the general public. The study's findings have led to the development of many therapeutic treatments (i.e., antihypertensive and cholesterol-lowering drugs) and preventative measures (i.e., exercise programs and smoking-cessation classes). As a result, the lives of tens of millions of individuals throughout the world have been saved and prolonged.

A Change of Heart, by Daniel Levy and Susan Brink, is the first popular account of this enormously important study. The authors are well qualified [End Page 113] to write this book; Levy is the study's current medical director, and Brink is a national health reporter for U.S. News & World Report. In the book, Levy and Brink describe the nearly-sixty-year history of the Framingham study from its beginning to the present. (The study is still ongoing.)

The Framingham study began in 1948, when little was known about the general causes of coronary heart disease. To identify the etiology of the disease, the U.S. Public Health Service (PHS) initiated an epidemiologic prospective, follow-up study of a cohort of adults in the town of Framingham, Massachusetts. Framingham was selected because it was self-contained and a typically American community. The study would follow a large cohort of healthy adults, who had no overt symptoms of coronary heart disease, for a long period of time to identify the risk factors associated with the development of the disease.

In 1949, the nascent Framingham study was transferred from the PHS to the newly formed National Heart Institute (now the National Heart, Lung, and Blood Institute of the National Institutes of Health). Over the next several years a cohort of 5,209 adults, 29–62 years of age, were recruited for an anticipated twenty-year study. Originally only men were going to be recruited, but women demanded to be part of the study and so also were included, making the Framingham study the first cardiovascular study to include women. Because the town of Framingham had few minority residents at the time, almost the entire original cohort was of European ancestry.

To establish biological and behavioral baselines, all of the study participants were given extensive physical and medical examinations and lifestyle interviews. Thereafter, they were reexamined every two years to determine who had developed coronary heart disease, as well as stroke, cancer, and other ailments. Today, after nearly sixty years, the study is continuing to examine and monitor the surviving participants of the original cohort.

The book also discusses other cohorts that were added to the study over the years to address new research questions and issues. In 1971, an offspring study, or second cohort study, was begun, enrolling 5,124 of the adult sons and daughters (and their spouses) of the original cohort to investigate the familial occurrence of coronary heart disease. In 1985, the Omni study, or minority cohort study, was begun, enrolling 500 members of Framingham's growing minority community to investigate the occurrence of coronary heart disease in that group. In 2002, the third-generation study, or third cohort study, was begun, enrolling 3,900 of the grandchildren of the original cohort to investigate the genetic factors associated with coronary heart disease.

Levy and Brink enliven the history of Framingham by interspersing in the text interesting and relevant medical histories, and interviews with various individuals involved in the study. For example, to demonstrate how [End Page...

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