The Framingham Heart Study, a massive public-health research effort now in its 77th year, is the foundational source for much of our current understanding of cardiovascular health and risk assessment. Originally focused solely on the heart, the study now tracks more than 15,000 participants to provide deep insights into brain, liver, and overall healthy aging.
The FHS inspired the first checklist for assessing heart disease risk, and much of our current knowledge about reducing cardiovascular disease can be traced directly to its findings. As part of a series interviewing leaders in the longevity field, we spoke with epidemiologist Dr. Donald Lloyd-Jones, the current head of the study and a professor at Boston University Chobanian & Avedisian School of Medicine, about the study’s findings on aging well.
This interview has been condensed and edited for clarity.
The Framingham Heart Study (FHS) is the longest-running community-based study worldwide. Launched in 1948, its original purpose was to identify the root causes of the emerging post-World War II epidemic of cardiovascular diseases, such as heart attacks and strokes. Researchers enrolled about a third of the population of Framingham, Massachusetts, aiming to systematically understand why heart disease was rapidly becoming the leading cause of death.
Although hypotheses suggested links between diet and smoking, these had never been consistently proven. The designers recognized the value of studying entire families, realizing that heart disease wasn’t exclusive to men and might have a familial component—decades before the discovery of DNA or serious consideration of genetics.
Participants underwent comprehensive examinations every two years, including physicals, blood collection, and measurement of height and weight. Researchers also collected detailed information on health habits and activities.
By the early 1960s, the FHS provided a strong signal demonstrating that blood cholesterol, blood pressure, and smoking were tightly linked to cardiovascular risk. Soon after, they established relationships with body weight, sedentary lifestyle, and specific dietary aspects. Framingham is thus credited with mapping out what are now considered the traditional risk factors for cardiovascular disease.
Following the initial success, the study expanded by enrolling over 5,000 offspring of the original participants, along with their spouses. This expansion helped researchers investigate not only genetic linkages but also environmental linkages shared between spouses. Examinations for this Offspring Cohort occurred every four years, while the original cohort continued bi-annual checks through the 1970s, 80s, and 90s.
During this period, the FHS refined its understanding of risk factors, distinguishing between total cholesterol and its subcomponents, and recognizing that systolic blood pressure posed a greater danger than diastolic pressure. Researchers also identified superior types of physical activity and dietary factors.
In 2002, the FHS enrolled the third generation of related individuals. Crucially, the town of Framingham had become significantly more diverse—shifting from an almost exclusively white, European-ancestry mill town in 1948 to a community including Asian and Brazilian heritage populations by the 90s and 2000s.
Today, the study follows six different groups. Leveraging modern technology, researchers can fully sequence DNA, analyze epigenetic modifications, and collect data on proteomics, metabolomics, and microbiomics. Non-invasive imaging allows them to observe disease development across various organs. While it remains the Framingham Heart Study, its scope has expanded significantly, focusing on the process of aging across every organ system, including the brain, bone, kidney, lung, and liver, given the depth of life-course data collected.
To help individuals reduce the risk of diseases associated with aging, Dr. Lloyd-Jones points to the American Heart Association’s platform, Life’s Essential Eight. This framework, influenced by FHS evidence, allows people to measure their cardiovascular health status today and is strongly linked to positive long-term health outcomes, including reduced risk for Alzheimer’s disease, cancer, and arthritis.
If you focus on your cardiovascular health, you will see simultaneous benefits across chronic diseases of aging. The eight components are all modifiable and actionable, focusing on optimizing healthspan—extending the years lived without sickness, not just lifespan:
- Healthy diet
- Physical activity
- Avoiding all forms of nicotine exposure (including combustible cigarettes)
- Healthy sleep
- Healthy weight
- Healthy blood pressure
- Healthy blood sugar
- Healthy blood lipids
Despite 60 years of data confirming these risk factors, society struggles to implement these findings into public health policies and clinical practice. Although the message is simple, our environment, neighborhoods, and food supply are often not designed to optimize these healthy behaviors.
However, successful implementation is possible. In the early 1970s, Finland had the world’s highest coronary heart disease death rates. By applying information derived from Framingham, they redesigned public health policies in a high-risk county—implementing smoking policy changes, assisting people in quitting, and subsidizing fruits and vegetables instead of meat.
The results were immediate: coronary heart disease rates began to fall. Within 30 years, the national death rates declined by 84%, moving Finland from the worst to the best in the world for coronary disease death rates.
In the U.S., death rates from heart disease fell by about 70% between 1968 and 2010 due to clinical and public health improvements. Unfortunately, this progress has leveled off, and perhaps even reversed since 2011, largely due to the obesity epidemic driving increases in blood pressure, blood sugar, and adverse cholesterol levels. Dr. Lloyd-Jones stresses that we understand everything necessary to prevent cardiovascular disease; implementing that knowledge will expand healthy aging.
Looking ahead, Dr. Lloyd-Jones hopes the study can continue to represent Framingham and enroll the fourth and fifth generations. Chronic disease research increasingly shows that prevention must begin much earlier in the life course, as diagnosis often occurs too late.
A hopeful conclusion drawn from a descendant study of the FHS is that lifestyle triumphs over genetics. Researchers found that people with high-risk genes who maintained a good lifestyle lived 12 years longer, on average, than those with good genes but poor lifestyle habits. Crucially, they lived 19 years longer, on average, without cardiovascular disease.
Genetics are not destiny; individuals can significantly bend the curve toward longer healthspans by pursuing healthy lifestyle options. While much is in individual control, policy support is crucial: we need affordable fruits and vegetables, safe streets for physical activity, and public health policies that protect citizens from environmental toxins like indoor air contamination.
