The Contribution of the Framingham Heart Study to the Prevention of Cardiovascular Disease: A Global Perspective

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Abstract

The Framingham Heart Study has been a trailblazer in the field of cardiovascular epidemiology. The wealth of novel scientific data that it has generated over 5 decades has made a significant contribution to cardiovascular disease (CVD) prevention in the United States and indirectly influenced global CVD prevention strategies. The Framingham Study has provided insights into the prevalence, incidence, prognosis, predisposing factors, and determinants of CVD. The now well-established risk factor concept, fundamental to prevention of CVD, originated from the Framingham study. It generated seminal findings such as the effects of tobacco use, unhealthy diet, physical inactivity, obesity, raised blood cholesterol, raised blood pressure, and diabetes on CVD. When these findings were first published, these were novel cardiovascular risk factors, now they are the major focus for global and national prevention efforts for reducing the burden of CVD and other major noncommunicable diseases. The Framingham Heart Study has also been in the forefront of the development of cardiovascular risk prediction equations for assessment of absolute risk. Further developments in this area including the development of World Health Organization/International Society of Hypertension risk prediction charts have resulted in a paradigm shift in CVD prevention strategies, from a single risk factor focus to a more cost-effective total cardiovascular risk approach, an approach recommended by the World Health Organization for CVD prevention worldwide.

Section snippets

The global burden of cardiovascular disease

Prevention of cardiovascular disease (CVD) is a global public health priority. Not only is CVD the leading cause of death in the world, it also contributes to almost one third (29%) of global deaths.1 According to the World Health Organization (WHO) estimates, 88% of the global CVD burden is in lower- and middle-income countries (LMICs).1 Out of the total of 17.1 million CVD deaths, 12.9 million deaths (coronary heart disease [CHD] deaths; 7.2 million; cerebrovascular disease deaths, 5.7

The place of the Framingham Study in the history of CVD prevention

A large body of scientific evidence has established that behavioral risk factors (tobacco use, unhealthy diet, and physical inactivity) are major underlying causes of the CVD burden. This information was not available in the late 1940s, when the CVD burden was a growing public health problem mainly in high-income countries. In 1948, recognizing the need for a cardiovascular research study to investigate the causes of the rising burden of CVD, the Public Health Service in the United States of

Importance of major cardiovascular risk factors

Pioneering work conducted in the Framingham project in the United States in early 1960s provided the impetus for further research in other high-income countries. In the late 1960s, the Seven Countries Study, an international collaborative initiative, was started to explain the variation in cardiovascular mortality in 7 countries.34 Study populations extended over the full range of mortality rates, from Finland (high), to the United States of America, the Netherlands, Italy, Yugoslavia, Greece,

Framingham Study and the basis for prevention of CVD

The concept of cardiovascular risk that originated in the Framingham Study is now well established because of a large body of scientific evidence related to risk factors and interventions for their prevention.39, 40 This evidence base contributed to by studies conducted worldwide including the Framingham Study provides a strong basis for the prevention of CHD and cerebrovascular disease.40 Because of the universality of cardiovascular risk factors, approaches to prevention of CVD can be based

Statement of Conflict of Interest

The author declares that there are no conflicts of interest.

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