During the twentieth century, while public health efforts brought common infectious diseases like tuberculosis under control, a new health epidemic emerged and became the leading cause of death worldwide: heart disease. The specific kind of heart disease for this major source of death and disability primarily involves blockages of the heart's blood vessels, the coronary arteries, and is frequently referred to as "coronary heart disease." By 1948, one in three deaths in the United States was caused by coronary heart disease, more than four times the rate in 1900.

Faced with this growing epidemic, Dr. Joseph Mountin, the US Assistant Surgeon General and head of the Division of Chronic Diseases at the US Public Health Service, initiated an epidemiological study on heart disease in 1947. Mountin took a then-novel approach to this project. Previous studies of heart disease had focused on examining patients who had already developed the disease. Instead, Mountin decided to study a large group of healthy people over many years to identify the common factors or characteristics in those who eventually developed heart disease.

The town of Framingham, Massachusetts, was selected as the study site. More than 5,200 healthy men and women volunteered to participate in what soon became known as the Framingham Heart Study. Researchers gathered a detailed medical history and performed a physical examination and laboratory tests on each volunteer every two years, a study design that tracked an individual's health and lifestyle over long periods of time. By the early 1960s, the ongoing study led by Drs. Thomas Dawber and William Kannel had identified three important "risk factors" that were closely correlated with heart disease: high blood pressure, high cholesterol, and cigarette smoking. At the time, the concept of risk factors was new; it has since revolutionized our understanding of heart disease and many other diseases.

Now in its seventh decade, the Framingham Heart Study is the longest-running population study of heart disease in the world. Today, sequential examinations on both the offspring of the original Framingham cohort as well as a third generation of participants continue to provide new and valuable information in the quest to prevent heart disease. In the years since the original research was published in the 1960s, the study has added several new risk factors to the original set, including obesity, diabetes, and physical inactivity. As the result of the work of researchers and volunteers like those involved in the Framingham Heart Study, we now know that the risk of heart disease can be dramatically reduced in many people by making behavioral changes.

More recently, scientists have also identified genetic risk factors for heart disease and have learned that there are interplays between environmental and genetic risk factors. For instance, research has shown that a number of genetic mutations in the low-density lipoprotein (LDL) receptor can prevent the receptor from performing its normal role of removing LDL cholesterol ("bad cholesterol") from the blood. High levels of LDL cholesterol can then build up in the arteries and lead to cardiovascular diseases. Today, medical researchers are hopeful that by studying both the genetic and behavioral risk factors for heart disease they can better understand and treat this disease, or prevent it altogether.

Despite progress, heart disease is still the leading cause of death both worldwide and in the US, and there is still no "cure" of any kind. Clearly, the work of public health officials and the scientific community on this issue is far from done, and coronary heart disease will remain a crucial societal issue for many years. In this Spotlight, we feature a collection of videos, podcasts, articles, and other resources that will help you better understand heart disease. You can even take a questionnaire to estimate your own risk of heart disease and learn the steps you can take to lower your risk.

--Ingrid Lobo, Ph.D.

Image: Darnyi Zsóka/Wikimedia Commons.