Time for a Creative Transformation of Epidemiology in the United States

摘要

In 1948, when Barkley was elected vice president (under President Harry S Truman), the National Heart Institute launched the Framingham Heart Study, an innovative and now internationally recognized population-based epide-miological project that brought together prominent scientists with members of the community of Framingham, Massachusetts. Thirteen years later, in 1961, the Framingham investigators introduced the term risk factor into the medical lexicon.2 They described the links between incident coronary heart disease and hypertension, hypercholesterol-emia, and electrocardiographic left ventricular hypertrophy. Later reports described other risk factors, including smoking and diabetes. These early discoveries led to further research in risk factor elucidation and management, management that has contributed to the remarkable 50-year decline in cardiovascular mortality in the United States.