August 4, 2005
Health - Pursuing America’s No. 1 Killer
For more times than he can recall, Ken Bouchard has journeyed from Los Angeles to his hometown of Framingham, Mass. There, Bouchard willingly provides blood samples, dons heart monitors and details his eating habits.
While he could easily get a routine physical closer to home, this exam is anything but routine. Bouchard subjects himself to such poking and prodding to further the cause of scientific discovery. Like his 94-year-old mother, Bouchard is a participant in the Framingham Heart Study.
The landmark study, initiated in 1948, set out to observe a large population over time in order to uncover the causes of heart disease. While we take such knowledge for granted today, it was the Framingham Heart Study that helped reveal the role of blood pressure, cholesterol, diet, exercise and smoking in heart disease and stroke. It has generated 1,000 scientific papers and launched thousands of research projects around the globe.
Three years before the study began, President Franklin Delano Roosevelt had died from complications of untreated hypertension, and conventional wisdom held that high blood pressure was an unalterable result of aging.
Framingham proved otherwise. Dr. Daniel Levy, the study's current director and a faculty member at the medical schools of Harvard and Boston universities, said that by showing most of the risk factors for heart disease can be controlled by lifestyle behaviors, Framingham demonstrated that "family history is no longer destiny." Indeed, the data obtained by monitoring the health of more than 5,200 Framingham citizens essentially transformed the approach of medicine from treatment to prevention.
"The Framingham Heart Study introduced the concept of risk factors.... It changed the way we practice medicine," said Levy, who with journalist Susan Brink chronicled the study's genesis and its continuing challenges in "A Change of Heart: How the People of Framingham, Massachusetts, Helped Unravel the Mysteries of Cardiovascular Disease" (Knopf, 2005).
Levy noted that blood pressure and cholesterol levels have decreased dramatically in the last 30 years, down from an average of about 225 to about 205 today.
"From the 1960s to the present time, deaths from cardiovascular disease have declined by 60 to 70 percent," he told The Journal.
Despite this progress, however, heart disease remains the leading cause of death in the United States and claims some 950,000 lives every year. And while rates of many risk factors have declined, the incidence of obesity has dramatically increased, threatening to "reverse many of the major advances we've made in the past 30 years," Levy said.
Further, Levy estimates that one-third of the approximately 65 million Americans who suffer from high blood pressure remain unaware of their condition.
The federal government's guidelines for health screenings call for blood pressure testing at least every one to two years for adults older than 18. Cholesterol testing should begin at age 20. Adults who are at increased risk for coronary heart disease should also discuss aspirin therapy.
For healthy individuals with high cholesterol levels, and for those with established heart disease or diabetes, Levy strongly advocates cholesterol-lowering medications. These drugs, he said, have been found so safe and effective in high-risk populations that the benefits far outweigh any risks. Yet according to Levy, fewer than 25 percent of those who probably would benefit from cholesterol-lowering medications take them.
And regardless of blood pressure and cholesterol levels, a healthy lifestyle is always recommended. The American College of Cardiology advocates 30 minutes of exercise daily, as well as a diet low in fat and high in fiber, which includes at least five servings of fruits and vegetables each day. According to Levy, lowering cholesterol and blood pressure levels -- whether through lifestyle, medication or a combination of both -- provides beneficial results regardless of one's age.
The Framingham Heart Study is now entering its sixth decade, and has enrolled more than 5,000 children and 3,500 grandchildren of the original study participants. This has provided researchers with an unprecedented treasure trove of information to plumb for genetic secrets: DNA samples paired with three generations of clinical and laboratory data. "In the next few years, there will be important results coming from our genetic studies," Levy said. He hopes these findings will identify additional risk factors, some of which will be modifiable, as well as pinpoint disease-promoting genes. The study has also branched out to areas beyond the heart, such as arthritis, osteoporosis and Alzheimer's disease.
Levy noted that many of science's most important findings emerge gradually, rather than as dramatic, "front-page" discoveries.
"The principles of prevention and the lessons learned about treating modifiable risk factors have saved countless hundreds of thousands of lives," he said.
One of those lives may be that of second-generation study participant Bouchard. His father died from a heart attack at the age of 38, five months before Bouchard's birth. Bouchard, 58, works out daily and follows a low-fat diet.
When Bouchard treks to Framingham for whatever new test that may await him, his father is never far from his mind. And while Bouchard knows he can't change the past, he's confident that his efforts will save future lives.