A Numbers Game

We all walk around with lots of numbers in our head, and for many of us, in the last 10 years or so our “cholesterol number” became one of them. Because as almost everyone knows, too much cholesterol gums up the arteries, setting the stage for a heart attack. Yet if you turn back the clock 100 years, no one was talking about cholesterol In fact, clogged arteries remained an uncommon condition well into the 20th century. In 1910 William Osler, M.D., often called the father of modern medicine, described angina pectoris—painful chest. spasms caused when narrowed arteries impede the flow of blood to the heart—as a rare disease, claiming he hadn’t even seen a case until late in his practice, Today more than 7 million Americans have angina, and it’s a rare general practitioner, let alone cardiologist, who isn’t all too familiar with this condition. Angina is considered a definitive sign of coronary heart disease, or CHD, the No. | killer of both men and women in the United States.

Much of our knowledge about this silent killer comes from the residents of the small Massachusetts town of Framingham. It was 1948, at the height of postwar prosperity, when indoor malls were just coming into their own, cars were replacing feet as the primary mode of transportation, smoking was cool, and a steak dinner was the ultimate dining experience, That’s the year scientists from the U.S, Public Health Service chose the town to help them learn more about the growing epidemic of heart disease.

Back then no one used the phrase “risk factor,” knew that high blood pressure or high cholesterol could lead to heart disease, or understood that you could modify those risk factors and thus lower your chances of developing CHD.

Since the Framingham Heart Study began, more than 10,000 citizens—including the offspring of the first 5,209 healthy residents who signed on—have participated in what became one of the most important health studies in history. In addition to the ones listed above, the study is responsible for other landmark findings, including:

• The link between diabetes and CHD.
• The identification of diet and obesity as CHD risk factors.
• The discovery that a high level of HDL (“good” cholesterol) is associated with reduced risk of death.
• The identification of homocysteine, apolipoprotein E, and lipoprotein (a) as possible risk factors for heart disease.