This Book Review originally appeared in The Post & Courier, May 8, 2005

A Change of Heart: How the People of Framingham, Massachusetts, Helped Unravel the Mysteries of Cardiovascular Disease.  By Daniel Levy, M.D., and Susan Brink.

Half a century ago, modifiable cardiovascular risk factors were unknown and coronary disease cut “lives short with such methodical regularity that most Americans in 1948 regarded early death from heart damage as an unavoidable act of fate.”  On April 12, 1945, while he was signing papers and having his portrait painted, President Franklin Delano Roosevelt placed a hand to his forehead, stated that he had “a terrific headache,” and lost consciousness.  His physician, at his side within minutes, took his blood pressure.  “The numbers, an unsustainable 300/190, went well beyond an indication of danger.  They were evidence that the tragedy had already occurred.”

As early as 1931, there were, in retrospect, unmistakable indications that FDR suffered from escalating hypertension.  But hypertension was not understood then as it is today.  Treatment was neither available nor considered necessary.  As many as seventy percent of men smoked by the late 1940s and a “typical American breakfast was fried eggs with bacon or sausage and a side of toast slathered with butter.  Housewives skimmed the cream from the top of the milk bottles for coffee…Children would fight over who got to eat the crispy fat trimmed from the fried pork chop or steak.” 

There were a number of physicians eager to determine what could be done about heart disease.  Framingham, a small town in Massachusetts, was chosen as the location for an unprecedented and still unrivalled medical study.  Early researchers won the trust of the people of the town as well as the trust of the town doctors.  No small task in a time when many private physicians, wary of rumors of socialized medicine, viewed epidemiological studies sponsored by government institutions with suspicion. 

The transformative power of Framingham study on our understanding of identifiable and modifiable risk factors for cardiovascular disease cannot be overstated.  Indeed, the very term “risk factor” came out of the study.  Framingham “altered the slant of medicine from treatment to prevention” and empowered both patients and physicians to change what was once considered unalterable.  Twice in the study’s five decades it was nearly brought to a close, both times saved by the persistence and dedication of the physicians, epidemiologists, and staff.  Today, the study is in its third generation, following the grandchildren of original study participants and ever expanding our list of available tools for early identification and intervention. 

“Change of Heart,” co-written by the Study’s current director and a national health reporter, reads smooth and easy.  Medical terms are clearly explained.  It is a wonderful guide to the extraordinary efforts and sacrifices made over the last half century by volunteers and researchers alike. 

Reviewer Jason A. Zwiker studied Public Health at the University of South Florida and has worked in field epidemiology for many years.  He is a freelance writer based in Charleston.

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