Evaluating CMR

The Framingham Heart Study

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Cardiovascular disease (CVD), coronary heart disease (CHD) in particular, continues to be a leading cause of mortality and serious illness in Europe and North America (1). In 2004, an estimated 79,400,000 Americans had one or more signs of CVD (2). The same year, CVD caused approximately 871,500 deaths and accounted for 36.3% of all mortality in the United States (2). A number of risk factors, including hypertension, cigarette smoking, dyslipidemia, diabetes, and obesity, increase CHD risk (3-5), and it has been shown that more and more people in the United States have two or more of these CHD risk factors (6). CHD risk is multifaceted, and a crucial aspect of CHD prevention is estimating patients’ global risk by evaluating the presence or severity of CHD risk factors.

In this regard, the Framingham Heart Study was launched in the 1940s to better understand the nature and cause of heart disease. The study was conducted under the direction of the National Heart Institute (now known as the National Heart, Lung, and Blood Institute (NHLBI)) (7). The Framingham Heart Study was an ambitious longitudinal investigation of genetic and environmental factors influencing the development of CHD in initially asymptomatic men and women. The study’s main goal was to understand the factors underpinning the development of CHD in the population. Study investigators sought to identify common CHD risk factors by following a large cohort of asymptomatic participants, some of whom later developed CHD, over a long period of time.

Before the Framingham study, little was known about the causes of heart disease even though CHD was becoming an American epidemic. At the time, atherosclerosis and high blood pressure were believed to be an inevitable part of aging, and the notion of potentially modifiable risk factors did not play a role in standard medical practice. The Framingham Heart Study changed all this by making a number of seminal contributions to the identification of major CHD risk factors. Subsequent mechanistic and basic studies have enabled clinicians/scientists to better understand the factors involved in heart disease and develop preventive approaches to prevent early development of CHD and enhance CHD treatment.

Reference

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1. McGovern PG, Pankow JS, Shahar E, et al. Recent trends in acute coronary heart disease--mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators. N Engl J Med 1996; 334: 884-90.

2. American Heart Association, http://www.americanheart.org/presenter.jhtml?identifier=4478/, last accessed in August 2007.

3. D'Agostino RB, Sr., Grundy S, Sullivan LM, et al. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA 2001; 286: 180-7.

4. Greenland P, Knoll MD, Stamler J, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA 2003; 290: 891-7.

5. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290: 898-904.

6. Greenlund KJ, Zheng ZJ, Keenan NL, et al. Trends in self-reported multiple cardiovascular disease risk factors among adults in the United States, 1991-1999. Arch Intern Med 2004; 164: 181-8.

7. National Heart, Lung, and Blood Institute (NHLBI), http://www.nhlbi.nih.gov/about/framingham/, last accessed in August 2007.

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