Perhaps the most important study in the history of heart research began during 1948 in the small Massachusetts town of Framingham. Inhabitants received medical examinations and supplied information about their diet and lifestyle with doctors monitoring their health over the ensuing years. The aim was to determine “factors influencing the development of heart disease,” and the results demonstrated clearly, and for the first time, that smoking, high blood pressure and too much cholesterol are major risk factors.
The Framingham project, together with further population studies showing that coronary illness is more common in people who seldom take exercise, demonstrated how heart disease could be prevented.27 Since the 1960s, when the United States had one of the highest death rates from coronary disease in the world, mortality has fallen sharply, declining by 25% within a decade.7 The improvements are in line with changes in diet and lifestyle18 with specific medical measures such as bypass operations and coronary care units having only a small impact, at best.28
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