1
00:00:04,820 --> 00:00:09,270
In this lecture, we'll describe
the Framingham Heart Study, one

2
00:00:09,270 --> 00:00:12,180
of the most important
epidemiological studies ever

3
00:00:12,180 --> 00:00:15,110
conducted, and the
underlying analytics that

4
00:00:15,110 --> 00:00:18,170
led to our current understanding
of cardiovascular disease.

5
00:00:20,850 --> 00:00:24,060
To motivate how the study
affected our understanding

6
00:00:24,060 --> 00:00:27,870
of blood pressure today,
we describe the case

7
00:00:27,870 --> 00:00:30,060
of Franklin Delano
Roosevelt, FDR

8
00:00:30,060 --> 00:00:32,680
for short, who was the
President of the United States

9
00:00:32,680 --> 00:00:35,350
from 1933 to 1945.

10
00:00:35,350 --> 00:00:38,300
He was the longest-serving
president of the United States,

11
00:00:38,300 --> 00:00:41,220
and he led the country
during difficult times --

12
00:00:41,220 --> 00:00:43,460
the Great Depression,
and World War II.

13
00:00:43,460 --> 00:00:51,670
He died while President
on April 12, 1945.

14
00:00:51,670 --> 00:01:00,510
Before the presidency, FDR's
blood pressure was 140/100.

15
00:01:00,510 --> 00:01:03,680
Today, healthy blood
pressure is considered

16
00:01:03,680 --> 00:01:07,350
to be less than 120/80.

17
00:01:07,350 --> 00:01:14,070
So therefore, 140/100 is today
considered high blood pressure.

18
00:01:14,070 --> 00:01:18,650
One year before his death, his
blood pressure was 210/120.

19
00:01:18,650 --> 00:01:21,860
Today this is called
hypertensive crisis,

20
00:01:21,860 --> 00:01:24,920
and emergency care is needed.

21
00:01:24,920 --> 00:01:29,380
On the other hand,
FDR's personal physician

22
00:01:29,380 --> 00:01:33,000
said a moderate degree
of atherosclerosis

23
00:01:33,000 --> 00:01:37,500
although no more than
normal for a man of his age.

24
00:01:37,500 --> 00:01:42,180
Two months before his death,
his blood pressure was 260/150,

25
00:01:42,180 --> 00:01:48,960
and the day of his
death was 300/190.

26
00:01:48,960 --> 00:01:51,970
There were early misconceptions
in the first half

27
00:01:51,970 --> 00:01:56,729
of the 20th century
about blood pressure.

28
00:01:56,729 --> 00:01:59,600
High blood pressure, dubbed
essential hypertension,

29
00:01:59,600 --> 00:02:04,350
was considered important to
force blood through arteries,

30
00:02:04,350 --> 00:02:07,240
and it was considered harmful
to lower blood pressure.

31
00:02:07,240 --> 00:02:09,979
Today, of course,
we know better.

32
00:02:09,979 --> 00:02:13,100
In the words of Daniel Levy,
the Framingham Heart Study

33
00:02:13,100 --> 00:02:18,110
director, "today presidential
blood pressure numbers

34
00:02:18,110 --> 00:02:21,310
like FDR's would send the
country's leading doctors

35
00:02:21,310 --> 00:02:24,690
racing down hallways,
whisking the nation's leader

36
00:02:24,690 --> 00:02:32,020
into the cardiac care unit
of Bethesda Naval Hospital."

37
00:02:32,020 --> 00:02:32,980
So how did we learn?

38
00:02:36,360 --> 00:02:39,329
In the late 1940s,
the US government

39
00:02:39,329 --> 00:02:43,220
set out to better understand
cardiovascular disease.

40
00:02:43,220 --> 00:02:46,890
The plan was to track a large
cohort of initially healthy

41
00:02:46,890 --> 00:02:50,350
patients over their lifetimes.

42
00:02:50,350 --> 00:02:54,950
A city was chosen, the city
of Framingham, Massachusetts,

43
00:02:54,950 --> 00:02:58,890
to be the site for the study.

44
00:02:58,890 --> 00:03:03,130
Framingham has an
appropriate size.

45
00:03:03,130 --> 00:03:05,040
It's not too large,
it's not too small.

46
00:03:05,040 --> 00:03:10,890
It has a stable population
that doesn't move too much.

47
00:03:10,890 --> 00:03:14,690
And the doctors and residents
were quite cooperative.

48
00:03:14,690 --> 00:03:20,180
So in 1948, the Framingham
Heart Study started.

49
00:03:24,660 --> 00:03:32,820
The study included 5,209
patients, aged 30 to 59.

50
00:03:32,820 --> 00:03:34,690
Patients were given
a questionnaire

51
00:03:34,690 --> 00:03:38,930
and an examination
every two years.

52
00:03:38,930 --> 00:03:41,820
During this examination,
their physical characteristics

53
00:03:41,820 --> 00:03:45,260
were recorded, their behavioral
characteristics, as well as

54
00:03:45,260 --> 00:03:48,120
test results.

55
00:03:48,120 --> 00:03:53,020
Exams and questions
expanded over time,

56
00:03:53,020 --> 00:03:56,560
but the key in the study
was that the trajectory

57
00:03:56,560 --> 00:03:58,270
of the health of
the patients was

58
00:03:58,270 --> 00:04:02,260
followed during their
entire lifespan.

59
00:04:02,260 --> 00:04:06,530
In this class, we
will build models

60
00:04:06,530 --> 00:04:10,750
using the Framingham data
to predict and prevent

61
00:04:10,750 --> 00:04:12,580
heart disease.