Wong Nathan D, Levy Daniel
Heart Disease Prevention Program, University of California, Irvine, CA, USA.
Framingham Heart Study, Framingham, MA, USA; Center for Population Research of the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Glob Heart. 2013 Mar;8(1):3-9. doi: 10.1016/j.gheart.2012.12.001. Epub 2013 Mar 15.
With the dramatic rise in coronary heart disease (CHD) during the first half of the 20th century, the newly formed National Heart Institute realized the significant gap in knowledge about the causes of CHD and embarked in 1947 on planning what was to become the renowned Framingham Heart Study. Dr. Thomas Royal Dawber's initial paper on the design of the project described studying up to 6,000 persons in a single geographic area and the formation of a technical advisory committee of 11 physicians in cardiology and public health to determine the hypotheses and protocol. A comprehensive physical examination and series of measurements and laboratory work were proposed and the initial examination was completed in 1952. The first paper describing 4 years of follow-up was published in 1957, and this was followed by a subsequent report in 1959 describing 6 years of follow-up. The first follow-up report described sex and age group differences in incidence of CHD and pointed out the noteworthy prominence of sudden cardiac death as the first manifestation of CHD and the initial observations regarding the significance of elevated blood pressure, cholesterol, and overweight in predicting future CHD. Importantly, the significance of a combination of risk factors for identifying those at highest risk was described as well as how the number of risk factors related to risk (the beginnings of what was decades later to become the famous risk scores from Framingham). Dr. William Kannel's 1961 publication, "Factors of Risk in the Development of Coronary Heart Disease," first highlighted the term risk factors, and it described how specific levels of cholesterol, blood pressure, as well as how electrocardiographic left ventricular hypertrophy predicted future CHD incidence. The standardized measurement of risk factors and follow-up in Framingham served as an important precedent for future observational studies designed and directed by what is now the National Heart, Lung, and Blood Institute, including the ARIC (Atherosclerosis Risk in Communities) study, the CARDIA (Coronary Artery Risk Development in Young Adults) study, the CHS (Cardiovascular Health Study), and the MESA (Multiethnic Study of Atherosclerosis). These studies and others continue the legacy that Framingham began more than 60 years ago into the investigation of the epidemiology of cardiovascular diseases.
随着20世纪上半叶冠心病（CHD）发病率的急剧上升，新成立的国家心脏研究所意识到在冠心病病因知识方面存在重大差距，并于1947年开始规划后来著名的弗雷明汉心脏研究。托马斯·罗亚尔·道伯博士关于该项目设计的初始论文描述了在一个地理区域内研究多达6000人，并组建了一个由11名心脏病学和公共卫生领域医生组成的技术咨询委员会来确定假设和方案。提出了全面的体格检查、一系列测量和实验室检查，初始检查于1952年完成。描述4年随访情况的第一篇论文于1957年发表，随后在1959年又有一篇描述6年随访情况的报告。第一篇随访报告描述了冠心病发病率的性别和年龄组差异，指出心脏性猝死作为冠心病的首发表现值得关注，以及关于血压升高、胆固醇升高和超重对预测未来冠心病的意义的初步观察结果。重要的是，还描述了多种危险因素组合对于识别高危人群的意义，以及危险因素数量与风险的关系（这是几十年后弗雷明汉著名风险评分的开端）。威廉·坎内尔博士1961年发表的《冠心病发展中的危险因素》首次突出了“危险因素”这一术语，并描述了特定胆固醇水平、血压水平以及心电图左心室肥厚如何预测未来冠心病发病率。弗雷明汉对危险因素的标准化测量和随访为现在的国家心脏、肺和血液研究所设计和指导的未来观察性研究树立了重要先例，包括社区动脉粥样硬化风险（ARIC）研究、青年成人冠状动脉风险发展（CARDIA）研究、心血管健康（CHS）研究和动脉粥样硬化多族裔研究（MESA）。这些研究及其他研究延续了弗雷明汉60多年前开启的心血管疾病流行病学调查的传统。
