Progress in Cardiovascular Diseases RSS feed: Current Issue. Each issue of Progress in Cardiovascular Diseases comprehensively covers a single topic in the understanding and treatment of disorders of the heart and circulation. Some issues include special articles, definitive reviews that capture the state of the art in the management of particular clinical problems in cardiology. Recent Topics The Myths Surrounding Diastolic Heart Failure Guest Editor: Dirk L. Brutsaert Hypertension Guest Editor: Franz Messerli Resynchronization Therapy Guest Editor: Jonathan S. Steinberg Atrial Fibrillation Guest Editor: Albert L. Waldo Diastolic Heart Failure Guest Editor: Michael R. Zile Troponins Drug Class Effects Guest Editor: James A. Reiffel Chest Pain Units Guest Editors: Ezra A. Amsterdam and J. Douglas Kirkhttp://www.onlinepcd.com/?rss=yesElsevier Inc.en © 2010 Elsevier Inc. All rights reserved. Progress in Cardiovascular Diseases0033-0620531July 2010 © 2010 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.onlinepcd.com/article/PIIS0033062010000897/abstract?rss=yesHistory is different from news. Headlines capture the excitement of the moment and announce the breakthroughs that may or may not influence our lives going forward. The inauguration rather than the fulfillment of what becomes defining events are rarely accorded their due and only in retrospect, in historical review, do we acknowledge their importance and significance.The Global Impact of the Framingham Heart Study: Editor's IntroductionHenry Greenberg10.1016/j.pcad.2010.05.003Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study12http://www.onlinepcd.com/article/PIIS0033062010000587/abstract?rss=yesThis issue of Progress in Cardiovascular Disease provides a perspective on the legacy of the Framingham Heart Study, an investigation that began in 1948. The original purpose of the study was to recruit a population sample without vascular disease from a community and to follow them for cardiovascular events over time. Within a decade of its inception, the Framingham investigators reported that age, male sex, blood cholesterol level, blood pressure level, presence of diabetes mellitus, and cigarette smoking were associated with greater risk for cardiovascular events. The research team subsequently expanded on these findings and described factors such as left ventricular hypertrophy, lipoprotein groups, inflammatory biomarkers, and genetic variants that were related to the development of vascular disease events. The interview in this issue that was conducted with Framingham investigator William Kannel provides a chronicle of these findings.Preface—Global Impact of the Framingham Heart StudyPeter W.F. Wilson10.1016/j.pcad.2010.03.006Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study33http://www.onlinepcd.com/article/PIIS0033062010000599/abstract?rss=yesDr Wilson: Welcome. This is an interview with Bill Kannel from the Framingham Heart Study, and the interview is being conducted by Peter Wilson from Emory University and Henry Greenberg from Columbia University and the Editor-in-Chief of Progress in Cardiovascular Diseases,Interview of William Kannel, MDPeter Wilson, Henry Greenberg10.1016/j.pcad.2010.03.007Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study49http://www.onlinepcd.com/article/PIIS0033062010000022/abstract?rss=yesAbstract: The Framingham Heart Study has been a trailblazer in the field of cardiovascular epidemiology. The wealth of novel scientific data that it has generated over 5 decades has made a significant contribution to cardiovascular disease (CVD) prevention in the United States and indirectly influenced global CVD prevention strategies. The Framingham Study has provided insights into the prevalence, incidence, prognosis, predisposing factors, and determinants of CVD. The now well-established risk factor concept, fundamental to prevention of CVD, originated from the Framingham study. It generated seminal findings such as the effects of tobacco use, unhealthy diet, physical inactivity, obesity, raised blood cholesterol, raised blood pressure, and diabetes on CVD. When these findings were first published, these were novel cardiovascular risk factors, now they are the major focus for global and national prevention efforts for reducing the burden of CVD and other major noncommunicable diseases. The Framingham Heart Study has also been in the forefront of the development of cardiovascular risk prediction equations for assessment of absolute risk. Further developments in this area including the development of World Health Organization/International Society of Hypertension risk prediction charts have resulted in a paradigm shift in CVD prevention strategies, from a single risk factor focus to a more cost-effective total cardiovascular risk approach, an approach recommended by the World Health Organization for CVD prevention worldwide.The Contribution of the Framingham Heart Study to the Prevention of Cardiovascular Disease: A Global PerspectiveShanthi Mendis10.1016/j.pcad.2010.01.001Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study1014http://www.onlinepcd.com/article/PIIS0033062010000046/abstract?rss=yesAbstract: The Framingham study was a landmark study that, already in the 1960s, gave strong evidence as to the likely causal role of several lifestyle-linked factors in the development of cardiovascular diseases (CVDs). Men in Finland had at that time the highest mortality rates of coronary heart disease in the world, a finding that raised much local concern. In 1972, a pioneering project by a young leadership team and with many partners, including World Health Organization, was started to change the situation. The project was based on the results for Framingham and some other classical studies to carry out a comprehensive prevention program to reduce the risk factor levels in the population through general lifestyle changes in the pilot area of North Karelia. Later on, the work was transferred to national level. Over the years, great reductions in the population levels of the risk factors took place, associated with dramatic reduction in age-adjusted CVD mortality rates and improvement in public health. The experience of diminishing the prevalence of risk factors in the population is a powerful demonstration of how the CVD epidemic can be successfully confronted—thatis, how the Framingham results can effectively be used for major progress in public health.From Framingham to North Karelia: From Descriptive Epidemiology to Public Health ActionPekka Puska10.1016/j.pcad.2010.01.003Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study1520http://www.onlinepcd.com/article/PIIS003306201000040X/abstract?rss=yesAbstract: India is in the middle of the epidemiological transition, with the burden of disease shifting towards chronic conditions, of which cardiovascular diseases (CVDs) form a major part. Findings from the Framingham Heart Study (FHS) have tremendous potential to circumvent the projected increase in CVD burden in India, as they highlight the importance of measuring risk in individuals and populations, and preventing future onset of disease. The findings of the FHS have stimulated several cross-sectional studies in India documenting a high and increasing burden of CVD risk factors. These have led to policy level changes in the country, in the form of Framework Convention on Tobacco Control ratification, and the National Program on Diabetes, CVD, and Stroke. There is now need for an Indian cohort study on the lines of the FHS, which can more closely evaluate the use of the FHS risk score among Indians and translate FHS findings into the Indian context.The Framingham Heart Study: Impact on the Prevention and Control of Cardiovascular Diseases in IndiaKolli Srinath Reddy, Ambika Satija10.1016/j.pcad.2010.02.011Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study2127http://www.onlinepcd.com/article/PIIS0033062010000885/abstract?rss=yesAbstract: Sixty years on from its first publication, the Framingham study has made an historic impact in risk identification and prediction of cardiovascular disease (CVD) burden globally. The challenge for the 21st century is in finding practical and scalable methods for effective implementation of population-level interventions that are adaptable to low-, middle-, and high-income settings.Within its first 2 years, the Abu Dhabi Cardiovascular Program, “Weqaya,” has delivered a Framingham Risk Score for almost every adult Emirati. This is complemented by a clear and progressive program including the health sector and societal approach to the delivery of interventions for CVD.The health sector response includes the use of clear, evidence-based standards of clinical care, customer-focused service innovation such as the use of mobile and wellness clinics, and attention to the patient experience, and improving compliance using a mixture of encourage, enable, and enforce mechanics.Components of the Abu Dhabi societal approach include “top-down” measures to align the civil sector response including use of policies and regulation, for example, for trade and urban planning. The “bottom-up” measures aim to empower individuals, groups, and populations. Key to the success of this approach lies in central coordination and routine monitoring and evaluation, incorporating the use of simple, shared metrics.The Abu Dhabi approach has created a solid platform for scalable intervention, and for “learning by doing,” with impact being monitored at the level of individuals, groups and the whole population. The unique data architecture in Abu Dhabi will enable the first cardiovascular risk score to be developed for the region and the incorporation of novel, modifiable risk factors into the model. The last 2 years have seen huge progress in Abu Dhabi for CVD, but the coming 5 to 10 years promise to unearth real, large-scale solutions, building on the original Framingham model. Furthermore, the Abu Dhabi model is scalable and adaptable to low- and middle-income country settings. Local and global data on CVD risk are stark and raise a clear challenge for public health; the time for clear actions has arrived.The Abu Dhabi Cardiovascular Program: The Continuation of FraminghamCother Hajat, Oliver Harrison10.1016/j.pcad.2010.05.002Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study2838http://www.onlinepcd.com/article/PIIS003306201000054X/abstract?rss=yesAbstract: Around one-quarter of the world’s adult population are defined as “hypertensive” however a much greater proportion are at risk of blood pressure-related disease because of the nature of the association between blood pressure and cardiovascular risk. The Framingham Study, together with other landmark observational studies, has been instrumental in elucidating this relationship. As early as the 1960s, Framingham showed that the association between blood pressure and cardiovascular risk was continuous and linear and was consistent across different age groups and for a range of major cardiovascular events. As the first major observational study to include substantial numbers of women, it was also able to debunk the myth that women “could tolerate blood pressure well”. In more recent decades, Framingham has been central to the development of the notion of absolute risk and the importance of blood pressure alongside other risk factors. Much of our current understanding of the role blood pressure in cardiovascular disease can be attributed to decades of high quality research from Framingham.Blood Pressure and Cardiovascular Disease: Tracing the Steps From FraminghamFiona Turnbull, Andre Pascal Kengne, Stephen MacMahon10.1016/j.pcad.2010.03.002Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study3944http://www.onlinepcd.com/article/PIIS0033062010000393/abstract?rss=yesAbstract: The global population of individuals with diabetes is important and rapidly growing. Because of the link between diabetes and cardiovascular disease (CVD), it is expected that diabetes will be an important driver of the future burden of CVD around the world. A connection between diabetes and CVD was suspected as earlier as in the mid 19th century. However, CVD in diabetes received less attention until the advent in the 20th century of treatments that allowed people with diabetes to live long enough to experience CVD. Since then the relationship between diabetes and CVD has been extensively investigated and characterised. The present article outlines the important contribution the Framingham Heart Study has made to the recognition of diabetes as a cardiovascular risk factor and the way in which the study has informed the association between other risk factors and CVD in the presence of diabetes, the changing pattern of the risk with time, and the quantification of CVD risk in the presence of diabetes. Through this contribution, Framingham has largely influenced our understanding of CVD in people with diabetes. Lines of investigation regarding cardiovascular health in this population are still wide open, and the Framingham Study continues to be part of this journey.The Framingham Study, Diabetes Mellitus and Cardiovascular Disease: Turning Back the ClockAndre Pascal Kengne, Fiona Turnbull, Stephen MacMahon10.1016/j.pcad.2010.02.010Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study4551http://www.onlinepcd.com/article/PIIS0033062010000873/abstract?rss=yesThe Framingham Heart Study (FHS) was conceived in response to a growing epidemic of cardiovascular disease (CVD) in the United States of America. It is critical to understand that at the time, in the late 1940s, the causes of CVD were still not well understood; the specific role of tobacco was regarded by the medical profession as contentious and in fact many doctors were advertising Camel cigarettes as their preferred brand! Epidemiologists at the time focused primarily, if not exclusively, on infectious diseases and some saw tuberculosis as the paradigm for understanding CVD. Major interventions in health were evolving fast with only a handful of antibiotics being used and some CVD treatments being available. Against this backdrop, the FHS set out to understand the causes of the largest epidemics in America with a view to proposing actions.From Framingham to the Framework Convention on Tobacco ControlDerek Yach10.1016/j.pcad.2010.05.001Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study5254http://www.onlinepcd.com/article/PIIS0033062010000551/abstract?rss=yesAbstract: The Framingham Heart Study remains the most famous and influential investigation in cardiovascular disease epidemiology. To generations of epidemiologists, it is a model for the cohort design. Here we revisit the origins of the Framingham Study before it became an accomplished and famous investigation whose existence and success are taken for granted.When in 1947 the Public Health Service initiated the study, knowledge of the distribution and determinants of coronary heart disease was sparse. Epidemiology was primarily focused on infectious disorders. Framingham's pioneers struggled to invent an appropriate epidemiological approach to this chronic disease and to establish support for a new kind of research within a community. Thereafter they had to convince skeptical medical professionals that the results of epidemiological investigations of heart disease were applicable to their clinical practices.Framingham Heart Study: The First 20 YearsGerald M. Oppenheimer10.1016/j.pcad.2010.03.003Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study5561http://www.onlinepcd.com/article/PIIS0033062010000058/abstract?rss=yesAbstract: This paper provides an overview of key achievements of the Framingham Heart Study and identifies areas and approaches for future research in cardiovascular disease epidemiology and prevention. There is a need for a range of different studies using diverse designs (i.e. case-control, cohort, multi-community, birth cohort, family-based cohorts and randomized trials) in different settings and involving multiple ethnic groups. Incorporation of a range of new disciplines, such as genetics, behavioural sciences, social epidemiology, measures of the environment, geography, and health policy are required to understand the root determinants of cardiovascular diseases.Deciphering the Causes of Cardiovascular and Other Complex Diseases in Populations: Achievements, Challenges, Opportunities, and ApproachesSalim Yusuf, Sonia Anand10.1016/j.pcad.2010.02.001Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study6267http://www.onlinepcd.com/article/PIIS003306201000085X/abstract?rss=yesAbstract: Cardiovascular disease (CVD) is the leading cause of mortality, responsible for about 30% of deaths worldwide. Globally, 80% of total CVD deaths occur in developing countries. In recent years, age-adjusted CVD death has been cut in half in developed countries. Much of the decline is due to reductions in risk factors that the Framingham Heart Study helped to identify. The Framingham Heart Study also helped to classify those at highest risk by creating multivariate risk scores. As a result, other investigators have created various risk prediction scores for their countries. These scores have been the foundation for guidelines and prevention strategies in developed countries. However, most scores requiring blood tests may be difficult to implement in developing countries where limited resources for screening exist. New studies and risk scores inspired by the Framingham Heart Study need to simplify risk scoring in developing countries so that affordable prevention strategies can be implemented.The Framingham Heart Study's Impact on Global Risk AssessmentAsaf Bitton, Thomas Gaziano10.1016/j.pcad.2010.04.001Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4The Global Impact of the Framingham Heart Study6878http://www.onlinepcd.com/article/PIIS0033062010000952/abstract?rss=yesTable of Contents10.1016/S0033-0620(10)00095-2Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4FrontmatterA1A1http://www.onlinepcd.com/article/PIIS0033062010000964/abstract?rss=yesList of recent issues10.1016/S0033-0620(10)00096-4Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4FrontmatterA2A2http://www.onlinepcd.com/article/PIIS0033062010000976/abstract?rss=yesEditorial Board10.1016/S0033-0620(10)00097-6Progress in Cardiovascular Diseases 53, 1 (2010)2010-07-01Progress in Cardiovascular Diseases2010-07-01531S0033-0620(10)X0004-4FrontmatterA3A3