Framingham Heart Study Celebrates 65 Years
Oct 03, 2013
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FRAMINGHAM, MA — The Framingham Heart Study (FHS), the longest-running study of cardiovascular disease and its risk factors, is turning 65 years old next week. The study, which had its start closely linked with the cardiovascular health of USPresident Franklin Delano Roosevelt, examined its first patient on October 11, 1948.
Dr Thomas Wang (Vanderbilt University Medical Center, Nashville, TN), an FHS associate when he was at Massachusetts General Hospital for the past decade, along with Dr Syed Mahmood (Harvard Medical School, Boston MA) and Drs Daniel Levy and Ramachandran Vasan (Boston University School of Medicine, MA) highlight the history of the FHS in a new review published online September 29, 2013 in the Lancet [1].
Speaking with heartwire , Wang said it would be difficult to highlight just a single contribution the FHS has made to the cardiovascular community, but the concept of the cardiovascular disease risk factor and later formalizing these risk factors into the Framingham Risk Score is a contribution that will endure. In addition, the study helped physicians understand the role hypertension plays in the development of numerous diseases, such as heart failure, MI, and stroke.
"Framingham has certainly also contributed to our understanding of blood pressures that we used to tolerate as within the 'normal range' and are, in fact, associated with an elevated risk of heart disease," said Wang. "It refocused our attention on people with lesser degrees of blood-pressure elevation. I think this has been one of the real values of the epidemiologic observations from Framingham."
President Roosevelt's Failing Health
The study was planned by the US Public Health Service in 1947, with Framingham, MA, selected as the study site. With the passing of the 1948 National Heart Act by President Harry Truman, $500 000 was set aside for the FHS and the first patient examined shortly thereafter.
Truman had been the vice president to Roosevelt and watched as the president was diagnosed with hypertension and heart failure in 1944. Roosevelt died of a stroke on April 12, 1945 and was reported to have a blood pressure of 300/190 mm Hg at the time of his cerebral hemorrhage. In 1932, his campaign released medical records showing that FDR had a blood pressure of 180/100 mm Hg, which his physician said was normal for a man his age.
"In some ways, focusing on an American president is convenient, because I don't think anyone would question that he would get what would be considered the best medical care at the time," said Wang. "It shows that back then much higher blood pressures were considered a natural fact of aging, when in fact there is nothing natural about it."
Budget Cuts and an Uncertain Future
The 65th anniversary of the FHS comes during an uncertain time. As reported by heartwire , the FHS will have its funding cut by 40%. The reason for the cutbacks is the automatic funding cuts that went into place as a result of the US government sequestration. The study is still continuing, but layoffs are expected later this year, including 19 administrative and clinical positions.
The FHS Offspring and Omni Group 1 exams scheduled for this year are still ongoing and ancillary studies are continuing as planned, and all medical-history updates are being collected as part of the schedule. However, the current cycle of FHS examinations will finish up in the fall of 2013, and no additional examinations of the participants are planned for the contract period. The current contract period expires March 31, 2015.
The FHS receives approximately $9 million from the US government through its contract with the National Heart, Lung, and Blood Institute (NHLBI). The funding is to be reduced by $4 million in upcoming years, a 40% reduction.
"The magnitude of cuts is clearly going to have an impact," said Wang. "One of the things that might happen is that the routine follow-up examinations that have been going on for 65 years may stop, and that will clearly change the nature of the study. Much of the study has been based on the personal interactions the investigators have had with the volunteers in the Framingham community."
Still, Wang said he is not disparaging the cutbacks, saying the National Institutes of Health (NIH) is simply trying to deal with the reality of the sequester. The Lancet review of the historic study was not intended as a swipe to the NIH, stressed Wang, telling heartwire they published the account to let other physicians and researchers know about the historic study's origins. The 65th anniversary simply coincided with the 2013 sequester and subsequent budget cuts.
The NIH had its 2013 fiscal year budget cut by $1.55 billion cut as a result of the sequester, and all institutes at the NIH were required to apply the cut across all programs, projects, and activities. Wang told heartwire the FHS investigators are continuing to look for other ways of funding the follow-up exams outside the NIH contract.
The authors report no conflicts of interest.
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