Premature mortality from coronary heart disease. The Framingham study

Since 1948, a cohort of 5,209 residents of Framingham, Mass, have been examined biennially. In the first 14 years, 120 died of coronary heart disease (CHD) before reaching 65 years of age. Two thirds of these deaths occurred outside the hospital—the majority suddenly— within one hour of onset of the terminal event. Nearly one half of the deaths from the initial coronary attack were sudden and unexpected. One half of all persons with sudden deaths had no prior clinical heart disease. While nonsudden coronary deaths were ordinarily preceded by clinical CHD, the disease was frequently first manifest close to the final episode. Only a small percentage of persons were seriously disabled six months before their death. Even among persons with known CHD, nearly one half of the deaths occurred outside the hospital. It is concluded that the only road to a substantial reduction in premature CHD mortality is prevention of CHD.