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People get heart disease. Too many people. So many.

According to the CDC:

So, that’s not going to work for us. Or our government.

Wasn’t it always like this?

Actually, no. Before 1950, infectious disease was the problem. But improved sanitation, vaccination, and the discovery of penicillin=far fewer infections.


Yes, but then heart disease.

Right. So then what happened?

Heart disease. Although heart disease was virtually unknown at the turn of the 20th century, over the 1940s heart disease rose to become the number one cause of death in the nation. By 1948, 44% of the deaths in the United States could be attributed to heart disease.

But we didn’t understand its causes. Studies of the spread of disease had focused on infectious diseases, like the flu, instead of non-infectious ones, like heart disease. Without better understanding of the causes of heart disease, no one knew how to prevent the disease. Something needed to be done.

That’s no good. What did we do?

In 1948, President Harry Truman signed the National Heart Act into law.

Whereas the Congress hereby finds and declares that the Nation’s health is seriously threatened by diseases of the heart and circulation . . . . These diseases are the main cause of death in the United States and more than one in every three of our people die from them.

The Act established the National Heart Institute, known today as the National Heart, Lung, and Blood Institute.

But we still have heart disease. So what was the point of the National Heart Act?

Many things. But in the first instance, it changed the way we researched and thought about heart disease.

In October 1947, while the National Heart Act was being drafted, the Public Health Service sent doctors to organize a heart disease study in the Boston area.

Alongside doctors and researches from the Massachusetts Department of Health and Harvard Medical School, they founded the Framingham Heart Study, the first long-term study of its kind. The Framingham Study would greatly expand our knowledge of heart disease, changing the way we fight the disease, and how we investigate illness.

And the National Heart Act?

Sorry, yes. The National Heart Act secured a $500,000 seed grant for the first 20-years of Framingham study. The study would go on to recruit 5209 men and women, more than half the adult population of Framingham. The study examined its first volunteer on September 29, 1948, and would continue to examine volunteers every two years. In the first 30 years of the study, only 3% of participants would drop out. That’s incredible.

It is. But what did we learn?

After Framingham, instead of focusing on treating those with heart disease, medical professionals began to focus on prevention. An apple a day keeps the doctor away. Same idea. But it was revolutionary at the time: they actually added the term “risk factor” to the medical lexicon in 1961.

Framingham investigators proposed a method of predicting risk from heart disease that is still in use today (the “Framingham Risk Score”). So, we now know more about how things like age, gender, cholesterol, diabetes, smoking and blood pressure contribute to the risk of heart disease. The CDC says that about half of Americans (47%) have at least one of these three risk factors.

You can do a risk assessment here using the Framingham Risk Score.

What’s happening with Framingham now?

Framingham is the gold standard of long term epidemiological studies. Basically, we do studies like this all the time now, all around the world.

And we’re actually still doing the Framingham study.

Framingham investigators continue to work with leading researchers from around the country and across the globe on projects in stroke and dementia, osteoporosis and arthritis, nutrition, diabetes, eye diseases, hearing disorders, lung diseases, and genetic patterns of common diseases. So, y’know, no big deal.

But didn’t you say heart disease was still the number one killer?

While heart disease remains the number one cause of death in America, this is much, much better than it used to be. In the 50s and 60s, more people died every year of heart disease than died of all other non-disease causes put together. At its peak in 1950, the age-adjusted death rate per 100,000 people was 588.8.   Today, thanks in large part to the governments efforts, this has fallen to 179.1. The 70% reduction in the death rate from heart disease is considered one of the public health triumphs of the 20th Century.

So what’s the upshot?

When heart disease was on the rise in America, our government passed a bill to start a big research project. One that’s still paying dividends and saving lives around the world – not just from heart disease but from so many other problems. And invented an entirely new way to study disease.

I love my Framingham Heart Study.

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