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What the Framingham Study Taught Us About Modifiable Risk Factors

Research leads to disease prevention, which is a key focus of many public health careers.

In 1948, with 5,209 participants, the U.S. Public Health Service launched the Framingham Heart Study (FHS).1 Now into its seventh decade and third generation of participants, the FHS continues to expand researchers’ knowledge of heart disease and ways of preventing it.

“Framingham changed the way we study and approach chronic diseases in the medical and public health spheres. Thanks in large part to Framingham, we now go beyond treating disease once it occurs by emphasizing disease prevention and addressing modifiable risk factors,” the National Institutes of Health (NIH) explains. “Framingham was an early pioneer in the use of epidemiology to study non-infectious diseases and gave rise to innovative methods that are being put to use in countless studies across the world.”1


The FHS, named for Framingham, Massachusetts, where the study began, today is a project of the National Heart, Lung, and Blood Institute and Boston University. The FHS research has produced many “firsts,” like discovering the effects of smoking and high blood pressure on heart health, for example. Before the FHS, heart disease was generally treated when it was discovered, often after a heart attack.1 Because of the FHS, doctors now assess and address risk factors with their patients during annual wellness visits to help prevent heart disease.

Prevention works. While heart disease is still the leading cause of death in the U.S.,2 the NIH says the death rate has declined dramatically since the late 1960s, the peak for heart disease deaths. From 1969 to 2013, a period over which researchers made many important discoveries, heart disease deaths in the U.S. fell 67.5% and stroke deaths fell 77%. The NIH attributes about half of the decline to risk factors being modified through lifestyle changes and medication.1

Since 1948, the findings have been wide-ranging and transformative. Here is a timeline of some of the top breakthroughs:1

1959: Cigarette smoking is linked to coronary heart disease.
1961: High blood pressure and high cholesterol levels are found to raise heart disease risk, and the term “risk factor” is popularized.
1967: Obesity and physical inactivity are determined to increase the risk for heart disease.
1970: High blood pressure is linked to increased risk of stroke.
1974: Diabetes is linked to risk of heart disease.
1976: Heart disease risk is found to increase in women after menopause.
1983: Irregular heartbeat (atrial fibrillation) is linked to stroke risk.
1984: The NIH publishes the first cholesterol guidelines, referencing Framingham findings.
1990: Left ventricular hypertrophy (thickening of the heart muscle) is identified as a significant risk factor for cardiovascular disease and death.
1998: The single most-cited scientific article from Framingham is published describing the “Framingham risk score”—an equation for calculating a person’s 10-year risk of heart disease.

“The Framingham risk calculator, which in many ways changed the practice of medicine, has been refined over the years to include other risk factors, and a suite of additional risk calculators based on Framingham research are now available,” the NIH says.1

In 2019, the FHS received $38 million in funding for the next six years.3 And so this “crown jewel of epidemiology”1 continues on, with a research agenda that includes studying the biology of aging and the role of genetics in heart disease.

Advance Wellness With a PhD in Public Health

The Merck Manual placed the Framingham Heart Study at No. 4 on its list of the 100 most significant advances in 20th-century medicine.1 This groundbreaking research can inform professionals in their PhD study, and in a variety of public health careers, including epidemiologist.

Earning a PhD in Public Health can help you play an influential role as a public health scholar, researcher, consultant, or health services leader. Walden University offers this advanced public health degree program in an online format that gives you the flexibility to work full time while furthering your education.

In Walden’s public health PhD program, your coursework will explore topics like disease and injury prevention and health informatics. As a PhD in Public Health candidate, you’ll conduct your own original research in a public health area of your choice, and you’ll learn how to apply public health research to promote positive social change in communities worldwide.

When you choose Walden for your public health degree, you may choose from two tracks: Track 1, designed for students who hold a Master of Public Health (MPH) or an MS in Public Health, and Track 2, designed for students who hold a bachelor’s degree or higher in an academic discipline other than the public health field.

As a Walden PhD in Public Health candidate, you’ll have the choice of three specializations to help you shape your public health career. In Epidemiology, you’ll expand your understanding of how infectious and chronic diseases affect people around the world and in your community. In Community Health Education, you’ll learn how to assess and improve the well-being of communities and public health systems. Your study will culminate in a community health assessment and the development of a public health program to address that community’s needs. In Environmental and Occupational Health you will learn more about how environmental health issues affect populations on a local, global and national scale. You will also learn to conduct scientifically rigorous research to find innovative solutions to environmental and occupational health challenges.

Depending on your experience and training, earning a public health PhD may qualify you for positions with top public health employers, in roles that could include epidemiologist, health department director, public health researcher, or educator.

Help build a healthier future by earning a PhD in Public Health at Walden, the leader in granting doctoral degrees in public health.4

Walden University is an accredited institution offering a PhD in Public Health degree program online. Expand your career options and earn your degree in a convenient, flexible format that fits your busy life.

4Source: National Center for Education Statistics (NCES) IPEDS database from 2014–2018. Collected using Burning Glass Technologies. Retrieved February 2020, using CIP code 51.22 (Doctorate degree – Public Health). Includes 2017–18 provisional data.

Walden University is accredited by The Higher Learning Commission,