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Last Updated: Saturday, 30 June 2007, 11:08 GMT 12:08 UK
Small town with a big heart
By Humphrey Hawksley
BBC News

Heart disease kills more than 17 million people a year worldwide and a study that has been under way in the US since the end of World War II has played a crucial role in determining the way the medical profession approaches it today.

Winnie Toy and family
Winnie Toy and her family have been part of the Study since 1948
The doctor totted up readings from a routine medical check I had just had: blood pressure, weight, cholesterol, whether or not I smoked.

He brought out a sheet of paper covered with yellow, red and green boxes, where he ringed some and wrote in others.

Then he tapped his pen on the desk, went quiet for a moment and wrote the figure "7" in a box marked "point total".

"Well," he announced, looking me hard in the eye, "there's a 13% chance you'll have a heart attack in the next 10 years."

"A what?" I asked incredulously.

"There's your age and your sex. But..." he paused hovering the pen over a box for cholesterol reading. "This is what you really need to get down."

"Yes," I countered. "But how can you tell me so exactly?"

"Ah," he replied with a thoughtful smile.

"That's the Framingham Heart Study. It's a town somewhere in America. We get all the data from there."

Case study

A few months later, I found myself walking through the centre of Framingham, Massachusetts.

It is about a half-hour drive from Boston, a slightly run-down, New England town with a colonial style town hall, a well-kept railway station, a high street of estate agents, lawyers, a pharmacy and - as a sign of the latest immigration trends - a couple of Brazilian restaurants.

In my day, if anyone talked about seeing a doctor... goodness me! And if it was the hospital, you didn't expect to see them again, the next stop was the morgue
Winnie Toy
By the bus stop, two overweight young women sat smoking.

A couple with iPods took a mid-morning jog through the park.

I examined Framingham's citizens with unusual intensity, but found nothing exceptional which, I suppose, is why 5,000 of them take part in what has become a global survey of why and how we get or inherit heart disease.

Learning curve

"President Roosevelt's death in 1945. That's what started us thinking," Dan Levy, director of the study, told me in an office lined with books about arteries, blood and hearts.

"Roosevelt died of a stroke. His blood pressure was through the roof. But we had no idea the two were connected," he said.

"So it was decided to take a large population and follow it for a long period of time. You see, in the mid-1940s there was the view that a heart attack was like a bolt out of heaven, unpredictable, no warning and that we had no ability to intervene."

"We now know that's not the case," he continued, "and that, if we could eradicate high blood pressure and high cholesterol, and wipe out cigarette smoking, heart disease would be almost unheard of."

Willing volunteers

Winnie Toy, with a shock of white hair and dressed in flamboyant yellow, greeted me on the steps of her family's house not far away.

She is 88, a formidable matriarch with a cutting wit, and a pioneer of the Framingham Heart Study.

Matt Toy
Our generation, we're like: 'You've got a headache? Take this. Can't sleep? Take this.'
Matt Toy

"I'd just got married," she said. "We didn't have any money and they were offering these wonderful free physicals... for nothing! So we said 'why not?' and we went."

She signed up in 1948. Her children joined in 1971 and her grandchildren in 2002.

"I'm a nurse by profession so I know how important this study is," said her 57-year-old daughter, Karyn, while topping up my coffee and offering cookies and fudge cake, not exactly the healthiest of food.

Her son, Matt, who is 32, caught the questioning look in my eye.

"Oh," he said. "They're from the meat and potatoes generation."

"And eggs," chipped in Winnie. "We were great egg eaters."

"So who's healthier?" I asked.

"Well I'm still here, aren't I," said Winnie. "You know, in my day, if anyone talked about seeing a doctor... goodness me! And if it was the hospital, you didn't expect to see them again, the next stop was the morgue."

"She might be right," said Matt laughing.

Medicine culture

Over the past four years, Matt - together with his younger brother Patrick- has undergone blood tests and physicals, and answered questions about his diet and lifestyle.

"When I joined the study," said Matt, "the doctor was shocked when I said I was almost 30 and wasn't taking any medication. Our generation, we're like: 'You've got a headache? Take this. Can't sleep? Take this.' Every other TV commercial is a drug for something that ails you."

Which brought me back to something on the mind right now of Britain's National Health Service.

Should millions of people with high cholesterol be given this wonder medicine - a statin - that might prevent heart disease but would make them drug dependent for the rest of their lives?

Framingham study director Dan Levy thought they should.

In fact, he warned that, if my own bad or "LDL" cholesterol was above four, I should take medication.

I asked the British Heart Foundation whether it went along with Framingham's findings.

"Absolutely," said Professor Peter Weissberg. "We take almost everything from Framingham."

"So, medication?" I ventured.

"We have a 20% risk threshold," he said. "Anyone above that we might seriously look at putting them on statins."

So my 13% risk?

"Absolutely not," he said. "Exercise and watch your diet."

From Our Own Correspondent was broadcast on Saturday, 30 June, 2007 at 1130 BST on BBC Radio 4. Please check the programme schedules for World Service transmission times.

SEE ALSO
Heart unit 'to cut waiting lists'
26 Jun 07 |  North East/N Isles
Warning over heart drugs increase
31 Oct 06 |  Scotland

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