114 THE CHINA STUDYSo how can we predict the timing of heart attacks? Unfortunately, with
existing technologies, we can't. We can't know which plaque will rup-
ture, when, or how severe it might be. What we do know, however, is
our relative risk for having a heart attack. What once was a mysterious
death, which claimed people in their most productive years, has been
"demystified" by science. No study has been more influential than that
of the Framingham Heart Study.FRAMINGHAM
After World War II, the National Heart Institutel3 was created with a
modest budget^4 and a difficult mission. Scientists knew that the greasy
plaques that lined the arteries of diseased hearts were composed of cho-
lesterol, phospholipids and fatty acids, 14 but they didn't know why these
lesions developed, how they developed or exactly how they led to heart
attacks. In the search for answers, the National Heart Institute decided
to follow a population over several years, to keep detailed medical re-
cords of everybody in the population and to see who got heart disease
and who didn't. The scientists headed to Framingham, Massachusetts.
Located just outside of Boston, Framingham is steeped in American
history. European settlers first inhabited the land in the seventeenth
century. Over the years the town has had supporting roles in the Revo-
lutionary War, the Salem Witch Trials and the abolition movement.
More recently, in 1948, the town assumed its most famous role. Over
5,000 residents of Framingham, both male and female, agreed to be
poked and prodded by scientists over the years so that we might learn
something about heart disease.
And learn something we did. By watching who got heart disease
and who didn't, and comparing their medical records, the Framingham
Heart Study developed the concept of risk factors such as cholesterol,
blood pressure, phYSical activity, cigarette smoking and obesity. Because
of the Framingham Study, we now know that these risk factors playa
prominent role in the causation of heart disease. Doctors have for years
used a Framingham prediction model to tell who is at high risk for heart
disease and who is not. Over 1,000 scientific papers have been pub-
lished from this study, and the study continues to this day, having now
studied four generations of Framingham residents.
The shining jewel of the Framingham Study is its findings on blood
cholesterol. In 1961, they convincingly showed a strong correlation be-
tween high blood cholesterol and heart disease. Researchers noted that