Factors of Risk in the Development of Coronary Heart Disease—Six-Year Follow-up Experience

Article1 July 1961Factors of Risk in the Development of Coronary Heart Disease—Six-Year Follow-up ExperienceThe Framingham StudyWILLIAM B. KANNEL, M.D., THOMAS R. DAWBER, M.D., F.A.C.P., ABRAHAM KAGAN, M.D., F.A.C.P., NICHOLAS REVOTSKIE, M.D., JOSEPH STOKES III, M.D.WILLIAM B. KANNEL, M.D.Search for more papers by this author, THOMAS R. DAWBER, M.D., F.A.C.P.Search for more papers by this author, ABRAHAM KAGAN, M.D., F.A.C.P.Search for more papers by this author, NICHOLAS REVOTSKIE, M.D.Search for more papers by this author, JOSEPH STOKES III, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-55-1-33 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIncreasingly reliable estimates of the prevalence and incidence of coronary heart disease (CHD) emphasize the importance of this disease as a contemporary health hazard. Cardiovascular disease is now the leading cause of death, with coronary heart disease accounting for two-thirds of all heart disease deaths. While advances in the diagnosis and therapeutic management of CHD have been made in the past decade, no important reduction in morbidity and mortality from CHD has occurred. This is apparent in the relatively slight increase in life expectancy at age 40 which has been achieved in the past several decades, while life expectancy at...References1. DAWBERMOOREMANN TRFEGV: II. Coronary heart disease in the Framingham Study. Amer. J. Public Health 47: 4, 1957. CrossrefGoogle Scholar2. DAWBERMEADORSMOORE TRGFFE: Epidemiological approaches to heart disease: the Framingham Study. Amer. J. Public Health 41: 279, 1951. CrossrefGoogle Scholar3. DAWBERMOORE TRFE: Longitudinal study of heart disease in Framingham, Massachusetts. An interim report: research in public health. 1951 Annual Conference of the Milbank Memorial Fund. Milbank Mem. Fund Quart. 1952. Google Scholar4. DAWBERKANNEL TRWB: An epidemiological study of heart disease: the Framingham Study. Nutr. Rev. 16: 1, 1958. CrossrefMedlineGoogle Scholar5. GORDONMOORESHURTLEFFDAWBER TFEDTR: Some methodologic problems in the long-term study of cardiovascular disease: observations on the Framingham Study. J. Chron. Dis. 10: 186, 1959. CrossrefGoogle Scholar6. DAWBERKANNELREVOTSKIESTOKESKAGANGORDON TRWBNJAT: Some factors associated with the development of coronary heart disease. Six years' follow-up experience in the Framingham Study. Amer. J. Public Health 49: 1349, 1959. CrossrefGoogle Scholar7. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Blood Vessels, Criteria Committee of the N. Y. Heart Association, 5th Ed., New York, 1953. Google Scholar8. ABELLLEVYBRODIEKENDALL LLBBBBFE: A simplified method for the estimation of total cholesterol in serum and the demonstration of its specificity. J. Biol. Chem. 195: 357, 1952. CrossrefMedlineGoogle Scholar9. : An evaluation of serum lipoproteins and cholesterol measurements as predictors of clinical complications of atherosclerosis: a report of a cooperative study of lipoproteins and atherosclerosis. Circulation 14: 691, 1956. CrossrefMedlineGoogle Scholar10. FRIEDBERG CK: Diseases of the Heart, 2nd Ed., W. B. Saunders Company, Philadelphia, 1956, p. 455. Google Scholar11. FRIEDBERG CK: Diseases of the Heart, 2nd Ed., W. B. Saunders Company, Philadelphia, 1956, pp. 317, 433, 543. Google Scholar12. DOYLEHESLINHILLEBOEFORMELKORNS JTSAHEPFRF: A prospective study of degenerative cardiovascular disease in Albany: report of three years' experience. I. Ischemic heart disease. Amer. J. Public Health 47: 25, 1957. CrossrefGoogle Scholar13. CHAPMANGOERKEDIXONLOVELANDPHILLIPS JMLSWDBE: The clinical status of a population group in Los Angeles under observation for two to three years. Amer. J. Public Health 47: 43, 1957. CrossrefGoogle Scholar14. CORNFIELDGORDONSMITH JTW: Quantal response curves for experimentally uncontrolled variables. Proceedings of the 32nd Session of the International Statistical Institute, Tokyo, 1960. To be published. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Framingham, MassachusettsReceived for publication April 19, 1961.From the Heart Disease Epidemiology Study, Framingham, Mass., and the National Heart Institute, National Institutes of Health, Public Health Service, U. S. Department of Health, Education, and Welfare, Washington, D. C.Presented at the Forty-second Annual Session, The American College of Physicians, May 8-12, 1961, Bal Harbour, Fla.Requests for reprints should be addressed to Thomas R. Dawber, M.D., F.A.C.P., Medical Director, Heart Disease Epidemiology Study, 25 Evergreen St., Framingham, Mass. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCelebrating the ACP Centennial: From the Annals Archive Deborah Cotton An Analysis of Calibration and Discrimination Among Multiple Cardiovascular Risk Scores in a Modern Multiethnic Cohort Andrew P. DeFilippis , Rebekah Young , Christopher J. Carrubba , John W. McEvoy , Matthew J. Budoff , Roger S. Blumenthal , Richard A. Kronmal , Robyn L. McClelland , Khurram Nasir , and Michael J. Blaha Metrics Cited byAtorvastatin impairs liver mitochondrial function in obese Göttingen Minipigs but heart and skeletal muscle are not affectedInfluence of Ile655Val polymorphism on trastuzumab-induced cardiotoxicity in early-stage HER2 positive breast cancerHemoglobin and hematocrit levels are positively associated with blood pressure in children and adolescents 10 to 18 years oldTemporal trends in cause-specific mortality among individuals with newly diagnosed atrial fibrillation in the Framingham Heart StudyUnsupervised Learning for Automated Detection of Coronary Artery Disease SubgroupsAtherosclerosis pathogenesis from the perspective of microvascular dysfunctionAssociation of Apolipoprotein B–Containing Lipoproteins and Risk of Myocardial Infarction in Individuals With and Without AtherosclerosisGut Microbiome Diversity and Composition Are Associated with Habitual Dairy Intakes: A Cross-Sectional Study in MenHypercholesterolemia risk associated Abca6 does not regulate lipoprotein metabolism in mice or hamsterGlobal epidemiology, health burden and effective interventions for elevated blood pressure and hypertensionVascular Tissue Specific miRNA Profiles Reveal Novel Correlations with Risk Factors in Coronary Artery DiseaseGut Microbiome in Chronic Coronary Syndrome PatientsWhich Microbes Like My Diet and What Does It Mean for My Heart?Medication-Related Osteonecrosis of the Jaw: A Critical Narrative ReviewThe Questions on Everyone’s Mind: What is and Why Do We Need Preventive Cardiology?Machine Learning Applications in Nephrology: A Bibliometric Analysis Comparing Kidney Studies to Other Medicine SubspecialitiesMiR-145-5p modulates lipid metabolism and M2 macrophage polarization by targeting PAK7 and regulating β-catenin signaling in hyperlipidemiaIs There a Role of Coronary CTA in Primary Prevention? Current State and Future DirectionsResilience of the Internal Mammary Artery to Atherogenesis: Shifting From Risk to Resistance to Address Unmet NeedsThe use of blood biomarkers in precision medicine for the primary prevention of atherosclerotic cardiovascular disease: a reviewTriglyceride-lowering and anti-inflammatory mechanisms of omega-3 polyunsaturated fatty acids for atherosclerotic cardiovascular risk reductionA unified framework identifies new links between plasma lipids and diseases from electronic medical records across large-scale cohortsCardiac well-being indexes: a decision support tool to monitor cardiovascular healthPredictability in Contemporary MedicineIs there more to a healthy-heart diet than cholesterol?Lead (Pb) exposure and heart failure riskFramingham Heart StudyVitamin D Deficiency Reduces Vascular Reactivity of Coronary Arterioles in Male RatsOmega-3 fatty acids ameliorate vascular inflammation: A rationale for their atheroprotective effectsGlucose variability and diabetes complications: Risk factor or biomarker? Can we disentangle the “Gordian Knot”?Utility of Coronary Artery Calcium Scores in Predicting Risk of Subclinical Cardiovascular Atherosclerotic Disease: An Analysis of Limitations to its Adoption With Policy RecommendationsA Compendium on HypertensionResveratrol enhances trans-intestinal cholesterol excretion through selective activation of intestinal liver X receptor alphaEfficacy and safety of non-vitamin K antagonist oral anticoagulants combined with antiplatelet drugs for patients with peripheral artery disease: A systematic review and meta-analysis of randomized controlled trialsGenetic Risk StratificationCardiovascular Disease Prediction Model Based on Logistic Regression and Euclidean DistanceAncel Keys: The legacy of a giant in physiology, nutrition, and public healthLipid reference values in an Irish populationMethodological education in response to the quality of COVID-19 publicationsThe Lymphatic System in Zebrafish Heart Development, Regeneration and Disease ModelingRole of Cardiac Biomarkers in Epidemiology and Risk OutcomesInflammation in Atherosclerosis—No Longer a TheoryPreventing Cardiovascular Disease Development Establishing Cardiac Well-Being IndexesSecondary Prevention and Cardiac RehabilitationPreventive Cardiology as Specialized Medical ArtCardiovascular Risk Assessment: From Global Risk Scoring to Risk Enhancing FactorsCardiovascular Disease in Women: Focus on Lipid ManagementThe Low-Density Lipoprotein Cholesterol Hypothesis: An UpdateBiomarkersProgress in ASCVD Risk Assessment in African Americans and Hispanic AmericansIdentifying endemic areas and estimating the prevalence of hyperlipidemia in Taiwan's townshipsFrancis Bacon, Vannevar Bush, and the coming fiscal pandemic of good healthThe traditional and modifiable risk factors of coronary artery disease – a community-based cross-sectional study among 2 populationsPatient-Perceived Versus Actual Risk of Cardiovascular Disease and Associated Willingness to Consider and Use Prevention TherapyPremature Mortality Due to Tobacco-Related Malignancies in PolandIt’s Time to Add Electrocardiography and Echocardiography to CVD Risk Prediction Models: Results from a Prospective Cohort StudyCardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability StudyLipid profiling in maternal and fetal circulations in preeclampsia and fetal growth restriction-a prospective case control observational studyParental cardiovascular health predicts time to onset of cardiovascular disease in offspringInula racemosa and Digitalis purpurea from Kashmir: Fatty acid composition, antioxidant, antibacterial activities, and functional group evaluationEffect of coconut oil on cardio-metabolic risk: A systematic review and meta-analysis of interventional studiesCharacterisation of recent trends in cardiovascular risk factors in young and middle-aged patients with ischaemic stroke and/or transient ischaemic attackAssociation between lipid fractions and age of first myocardial infarctionPrevalence of atherogenic dyslipidemia in young asymptomatic medical professionals of a Tertiary Care Hospital in South India: A cross-sectional studyPremature Parental Cardiovascular Disease and Subclinical Disease Burden in the OffspringThe Potential Role of Gut Microbiota in the Prevention and Treatment of Lipid Metabolism DisordersA Journey through Genetic Architecture and Predisposition of Coronary Artery DiseaseTargeting Ca2 + Handling Proteins for the Treatment of Heart Failure and ArrhythmiasNew Recommendations and Revised Concepts in Recent Guidelines on the Management of Dyslipidemias to Prevent Cardiovascular Disease: the 2018 ACC/AHA and 2019 ESC/EAS GuidelinesWho Benefits From Taking a Statin, and When?Dietary treatment to lower cholesterol and triglyceride and reduce cardiovascular riskCardiovascular imaging to guide primary preventionCoronary and peripheral artery plaques: do differences in plaque characteristics translate to differences in lipid management?Artificial Intelligence in Cardiac Imaging With Statistical Atlases of Cardiac AnatomySingle-nucleotide polymorphisms based genetic risk score in the prediction of pancreatic cancer riskEditorial: JUMBO, MRFIT, and the Making of Public Health EpidemiologyThe Evolution of Ischemia Detection with EchocardiographyHealth and Economics of Lifestyle Medicine StrategiesThe institutionalisation and deinstitutionalisation of the cholesterol theoryIntroduction to a special issue on breaking the disciplinary matrix: the ever-changing view of organizational theoryCoronary Risks Associated with Diclofenac and Other NSAIDs: An UpdateDifferences in mineral composition and morphology between men and women in aortic valve calcificationThe evolution of the heart-healthy diet for vascular health: A walk through timeCardiovascular risk assessment: The foundation of preventive cardiologyAssociation of body composition indexes with cardio-metabolic risk factorsRisk scores, atherosclerotic cardiovascular disease and the crystal ballBiomarkers in primary preventionNational trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: a pooled analysis of 458 population-based studies in Asian and Western countriesOmics and Cardiometabolic Disease Risk PredictionClinical Risk Assessment and PredictionComputed Tomography Imaging of Epicardial Adipose TissueA History of Mechanical Circulatory SupportOpportunities, challenges and expectations management for translating biobank research to precision medicineThe role of diet in chronic diseaseHitos históricos en el tratamiento hipolipemiante antes de la era de los inhibidores de la proproteina convertasa subtilisina/kexina tipo 9Lipoproteins and lipids in cardiovascular disease: from mechanistic insights to therapeutic targetingDevelopment and Validation of a Prognostic, Risk-Adjusted Scoring System for Operative Upper-Extremity InfectionsPreventive cardiology or cardiometabolic medicine: a new and emerging subspecialty?Alpinia zerumbet and Its Potential Use as an Herbal Medication for Atherosclerosis: Mechanistic Insights from Cell and Rodent StudiesToxin to medicine and bioisosterism in drug development: a study of the discovery and development of ACE inhibitors from snake venomGeneral concepts in biostatistics and clinical epidemiology: observational studies with cohort designAssociation of BUD13-ZNF259-APOA5-APOA1-SIK3 cluster polymorphism in 11q23.3 and structure of APOA5 with increased plasma triglyceride levels in a Korean populationEffect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: an overview of systematic reviewsInnovatively Established Analysis Method for Lipoprotein Profiles Based on High-Performance Anion-Exchange Liquid ChromatographyST‐Segment–Elevation Myocardial Infarction (STEMI) Patients Without Standard Modifiable Cardiovascular Risk Factors—How Common Are They, and What Are Their Outcomes?Regulation of glucose and lipid metabolism in health and diseaseWill Social Determinants Reshape Pediatrics? Upstream Clinical Prevention Efforts Past, Present, and Future70-year legacy of the Framingham Heart StudyLipid Management for the Prevention of Atherosclerotic Cardiovascular DiseaseIs Late Left Ventricle Remodeling After Repair of Degenerative Mitral Regurgitation Worse in Women?Glucocentric risk factors for macrovascular complications in diabetes: Glucose ‘legacy’ and ‘variability’-what we see, know and try to comprehendDiagnosis: From classification to predictionIs mitral valve disease treated differently in men and women?Refining the Association Between Body Mass Index and Atrial Fibrillation: G‐Formula and Restricted Mean Survival TimesThe “All of Us” Research ProgramExtreme Atherosclerotic Cardiovascular Disease (ASCVD) Risk RecognitionFamily health history: underused for actionable risk assessmentComparison of Heart Rate Blood Pressure Product Versus Age-Predicted Maximum Heart Rate as Predictors of Cardiovascular Events During Exercise Stress EchocardiographyCoronary Artery Calcium Scores of Zero and Establishing the Concept of Negative Risk FactorsFamilial Clustering of Cardiac Conduction Defects and Pacemaker InsertionEstimating the distribution of a novel clinical biomarker (FGF-23) in the US population using findings from a regional research registryA large‐scale exome array analysis of venous thromboembolismHeart Failure With Preserved Ejection Fraction In PerspectivePrecision Preventive Medicine—Ready for Prime Time?Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond–Forrester for the contemporary era and clinical implications: insights from the PROMISE trialImpact of cumulative SBP and serious adverse events on efficacy of intensive blood pressure treatmentIntensive Cardiac Rehabilitation: an Underutilized ResourceRelationship between major depressive disorder, generalized anxiety disorder and coronary artery disease in the US general populationEnhancer deletion and allelic effects define a regulatory molecular mechanism at the VLDLR cholesterol GWAS locusHealth Factors Associated with Cardiovascular WellnessNon-Traditional Cardiovascular Risk Markers in the Era of Established Major Risk Factors and Multiple GuidelinesEffects of Cornelian Cherry on Atherosclerosis and Its Risk FactorsIncorporation of Novel Vascular Measures into Clinical Management: Recent Insights from the Framingham Heart StudyFacteurs de risque et maladies chroniques : le diabète en exempleUtilizing state-of-the-art “omics” technology and bioinformatics to identify new biological mechanisms and biomarkers for coronary artery diseaseEvidence for a Causal Role of the SH2B3 -β 2 M Axis in Blood Pressure RegulationCapitalizing on Insights from Human Genetics to Identify Novel Therapeutic Targets for Coronary Artery DiseaseRisk stratification for coronary artery disease in multi-ethnic populations: Are there broader considerations for cost efficiency?Atherosclerosis Risk FactorsA Historical Journey on the Physiology of Blood Pressure MonitoringCardiovascular Disease and Acute Coronary Syndrome in the Adult Patient with Congenital Heart DiseaseUnanswered Questions Regarding Blood Pressure Management for HF PreventionCardiovascular Risk: Assumptions, Limitations, and ResearchPrediction of Heart Disease Using Random Forest and Rough Set Based Feature SelectionUsing Electronic Health Records To Generate Phenotypes For ResearchHigh-density lipoprotein suppresses tumor necrosis factor alpha production by mycobacteria-infected human macrophagesMicroRNA interactome analysis predicts post-transcriptional regulation of ADRB2 and PPP3R1 in the hypercholesterolemic myocardiumQuantifying the added value of new biomarkers: how and how notEffects of Ramelteon and Other Sleep-Promoting Drugs on Serum Low-Density Lipoprotein and Non-high-density Lipoprotein Cholesterol: A to in Public and of the Lipid and Glucose the New in Cardiovascular Risk Heart of the cardiovascular 40 in cardiovascular de la cardiovascular 40 en cardiovascular and After an Acute Myocardial of analysis in research through the review of the development of the Framingham Physiology of of Risks in plasma cholesterol and intestinal cholesterol biological and risk in the Framingham Heart disease lipoprotein but not lipoprotein in chronic disease a cross-sectional and inflammation: The the in in Role of and of cardiovascular risk Risk Prediction for Primary and Prevention of Atherosclerotic Cardiovascular Disease: an risk factors but not ischaemic in obese New to an of health in the and cardiovascular disease among with for and – for patients with peripheral artery of in cardiovascular disease: The of the genetic risk prevention of cardiovascular disease: The and of blood and clinical management and of patients with coronary artery study of serum and Cardiovascular Disease: Do We Need to in Patients with Disease With or Without Acute Vascular of Therapeutic or with in Cardiovascular and as cardiovascular risk of Lipoprotein Metabolism Learning for the of from and and in Cardiovascular Health History and Health Risk Assessment For Cardiovascular Disease in Health and in Cardiovascular in Atherosclerosis: and Its of Coronary Stress in Current and Future of Cardiovascular Health and Coronary Artery Calcium in and in the Framingham Heart of Resistance and Chronic Kidney Disease on and Cardiovascular of Heart Disease Using Random Forest and Rough Set Based Feature between the for and the risk of coronary heart and omega-3 are in in in of lipid in the Hispanic health of analysis for a with and among Major Risk Factors and the Burden of Cardiovascular and Chronic of plasma is positively associated with the risk of in stratification of in of myocardial patients with coronary by modifiable risk An Based past and a of Making in Disease ManagementThe for Blood Pressure disease in A and heart from to between Disease and Acute Vascular Events a Study at and cardiovascular risk factors – A life Memorial Time to and as Risk Factors for Cardiovascular human to guide drug of in newly diagnosed a cohort The Framingham of Cardiovascular of Cardiovascular Diseases Among and signaling by in vascular and heart health: A genetic insights into lipoproteins and risk of cardiometabolic of genetic in from blood pressure and coronary are to cardiovascular to Analysis with and Between and of between polymorphisms and coronary artery disease Fatty and in Blood The Role of in Cardiovascular of Cell of Risk and Serum A Study in a of of the polymorphisms and serum lipid the risk of coronary artery disease and to Genetic Risk Social for Markers and of Cardiovascular Health History and Health Risk Assessment in Health of a cardiovascular cohort in a report of the Health in of in Chronic Kidney Associated with Cardiovascular Risk on a of for Cardiovascular or from electronic health records to in cardiovascular studies using from epidemiology, and in the disease research using studies and Electronic health Records and of a Apolipoprotein After Acute Myocardial and long-term in the Framingham Heart an of the for a the Patient in Primary Prevention as as a Risk vascular growth factor and the risk of cardiovascular and of of coronary artery disease on liver prediction of coronary heart in and Clinical and blood lipids in A analysis in and of in women mitral of on health: public health in is an factor in coronary artery among and of in Ischemic A to the safety and of a human myocardial the major from and cholesterol levels in A leading for and health in the of and Management of Individuals With in Atrial of on hyperlipidemia and in patients with coronary artery in the to the of Coronary Artery of heart is associated with in a human of Cell of and of Novel serum lipoprotein cholesterol and lipoprotein A randomized of cardiovascular disease: recent novel on risk factors and clinical for Lipid of GWAS in the of the plasma lipids of studies on the