Framingham Study

The Framingham Heart Study pioneered the identification of “risk factors” for heart disease, and this ongoing and ambitious study continues to contribute to the understanding of heart disease and other cardiovascular and related illnesses. Of primary significance to psychology is that findings from this study identify psychosocial risk factors for heart disease and highlight the importance of positive lifestyle change in the prevention and treatment of cardiovascular illnesses.

What Led To This Investigation?

A major health shift occurred in the beginning of the 20th century, as cardiovascular disease became (and continues to be) the leading cause of death and illness in the United States. Little was understood about this foremost killer at the time, necessitating the formation of research to examine contributing factors to heart disease. The Framingham Heart Study was a response to this need and was originally designed to investigate the factors that predispose to cardiovascular diseases such as heart disease and stroke.

The Study: Three Generations And Going Strong

The Framingham Heart Study is a longitudinal study that has tapped into three generations of residents from the town of Framingham, Massachusetts, and has evolved in measurement and primary focus. In the first phase of the study, researchers collected extensive physical and lifestyle data on 5,209 primarily white adult men and women from Framingham, Massachusetts, with follow-up physical examinations every 2 years. Extensive psychosocial measures such as personality, anger, and stress were obtained between 1965 and 1967. During the first 30 years of the study, researchers assessed the relationship of clinical observations with the development of cardiovascular disease and through this process found that factors such as cigarette smoking, cholesterol levels, and psychosocial factors were related to heart disease.

The 1970s marked two important advances in the study: (1) the recruitment of offspring, and (2) new diagnostic technologies. A second generation of subjects was recruited beginning in 1971, with 5,124 adult children (of the original sample) and their spouses participating in the study. The physical examinations conducted were similar to earlier examinations; however, technological advances such as echocardiography and carotid artery ultrasound allowed for more refined observations of the heart.

Currently, the study is in its third phase with the recruitment  of  children  from  the  offspring  cohort. The primary focus of investigation in this phase of the study is the role of genetic factors in cardiovascular disease. In addition, the Omni Study of minorities was launched in 1995 to investigate similarities and differences among minorities from the primarily white cohorts in the Framingham Heart Study.

What Are The Risk Factors?

Major risk factors for coronary heart disease identified by the Framingham Heart Study include high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity. Other, related risk factors include blood triglyceride and HDL cholesterol levels, age, sex, and psychosocial issues. Most of the risk factors identified by the Framingham Heart Study can be modified by positive lifestyle change, highlighting the importance of psychology in the prevention and treatment of cardiovascular illness. In addition, psychosocial variables such as type A behavior and suppressed hostility (not discussing or displaying anger) have been identified as independent risk factors for coronary heart disease in both men and women.

Conclusion

Whereas the Framingham Heart Study is best known for its contributions to the understanding, prevention, and treatment of cardiovascular disease, data from this study also have been used to understand diseases such as osteoporosis and arthritis, diabetes, kidney disease, cancer, eye disease, hearing disorders, dementia, and lung diseases. More than 1,200 articles have been published in reputable journals, with more to come as the Framingham Study continues to contribute to our understanding of cardiovascular disease and the importance of lifestyle and psychosocial factors in health.

References:

  1. American Heart (2003). Heart disease and stroke statistics—2004 update. Dallas, TX: Author.
  2. American Heart Association Task Force on Risk (1998). Primary  prevention  of  coronary  heart  disease: Guidance from Framingham. Circulation, 97, 1876–1887.
  3. Eaker, E. , Sullivan, L. M., Kelly-Hayes, M., D’Agostino, R. B., & Benjamin, E. J. (2004). Anger and hostility predict the development of atrial fibrillation in men in the Framingham Offspring Study. Circulation, 109, 1267–1271.
  4. Haynes, G., Feinleib, M., & Kannel, W. B. (1980). The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart  disease.  American  Journal  of  Epidemiology, 111, 37–58.
  5. Haynes, S. G., Feinleib, M., Levine, S., Scotch, N., & Kannel, W.  (1978).  The  relationship  of  psychosocial  factors to coronary heart disease in the Framingham Study. II. Prevalence of coronary heart disease. American Journal of Epidemiology, 107, 384–402.
  6. Kannel, W. , & Eaker, E. D. (1986). Psychosocial and other features of coronary heart disease: Insights from the Framingham Study. American Heart Journal, 112(5), 1066–1073.
  7. National Institutes of Health, National Heart, Blood, and Lung Institute. (2002). Framingham Heart Study. Retrieved from http://www.nhlbi.nih.gov/about/framingham/indehtml