Preface—Global Impact of the Framingham Heart Study

This issue of Progress in Cardiovascular Disease provides a perspective on the legacy of the Framingham Heart Study, an investigation that began in 1948. The original purpose of the study was to recruit a population sample without vascular disease from a community and to follow them for cardiovascular events over time. Within a decade of its inception, the Framingham investigators reported that age, male sex, blood cholesterol level, blood pressure level, presence of diabetes mellitus, and cigarette smoking were associated with greater risk for cardiovascular events. The research team subsequently expanded on these findings and described factors such as left ventricular hypertrophy, lipoprotein groups, inflammatory biomarkers, and genetic variants that were related to the development of vascular disease events. The interview in this issue that was conducted with Framingham investigator William Kannel provides a chronicle of these findings.

Since the late 1940s, several population-based studies have been undertaken to assess risk for vascular disease. Prospective investigations similar to Framingham were undertaken in Tecumseh (MI), Chicago (IL), Charleston (SC), Goteborg (Sweden), Whitehall (London, United Kingdom), and Kuopio (Finland), the Seven Countries Study, and several other sites. A large number of case-control studies have also been undertaken and of particular interest is the international Inter-Heart Study. Investigators from several of these types of studies are contributors to this issue, and they describe methods and population research strategies that build on the experience of Framingham. For example, methodologies developed and refined in cardiovascular observational cohort studies include standardization of questionnaires, laboratory assessments, and adjudication of events. Clinicians take the pulse of a patient, and carefully conducted population studies take the “pulse” of a community, society, or group. Such observations have helped greatly in the planning and design of randomized clinical trials related to prevention of first cardiovascular events: treatment of blood pressure, therapy for dyslipidemia, reduction in smoking habit, and other interventions.

How have knowledge and research methods concerning cardiovascular disease in populations evolved since 1948? Initial evaluations were largely based on the history and physical examination. Technological assessments included electrocardiograms and later included a large variety of methods to assess risk factors and subclinical vascular disease, including echocardiograms, carotid ultrasound, brachial reactivity, ankle brachial blood pressure, pulse wave velocity, arrhythmia monitors, and blood pressure monitors.

This issue provides a variety of perspectives on the role that large population samples have played in the elucidation of the pathogenesis, prevalence, and incidence of cardiovascular disease. The contributors to this issue provide a global perspective on the role of observational population science and share their related expertise in clinical investigation, randomized clinical trials, and public health policy. Together, these articles will give the reader a greater understanding of this field of cardiovascular disease research and will demonstrate how far we have come since the Framingham Heart Study enrolled its first patient more than 60 years ago.