Pivotal Studies in Cardiac Prevention Highlight Power of Cohorts

The ASPC 2025 Congress on CVD Prevention opened on August 1 with a session that highlighted the progress that has been made in preventive cardiology, keeping the past in mind as doctors move into the future of research and medicine. In particular, Matthew Nayor, MD, MPH, and Keith Ferdinand, MD, FASPC, highlighted how the Framingham Heart Study and the Bogulasa Heart Study, respectively, have given insights into how to treat adults and children and prevent further heart problems.

Cohort studies have been the source of major innovation in preventive cardiology | Image credit: Ngampol - stock.adobe.com

Framingham Heart Study Provided Seminal Contributions to Preventive Cardiology

Nayor, an associate professor of medicine at Boston University Chobanian & Avedisian School of Medicine, spoke about the impact of the Framingham Heart Study1 on the practice as well as what the future of the study will contain.

According to Nayor, there have been 15,000 individuals included in the study over time, with the first examined individual participating in 1948. In 2025, more than 6000 surviving participants have contributed several times. The study has continued in part because the National Institute of Health and Boston University partnered in 1971 to continue the study. The Omni cohort was also added to the mix in 1994 to expand the demographics of the cohort.

Nayer emphasized that the findings from Framingham have affected the age-adjusted death rate for cardiovascular disease throughout the 20th century, as deaths started to fall in the 1950s and 1960s. A 1957 study reported on coronary heart disease.

“[The study] described really, for the first time, these physiologic drivers of cardiovascular disease, such as high blood pressure, high cholesterol, and being overweight,” said Nayer. “In a follow-up study in 1961, the investigators used the phrase factors of risk in the development of coronary heart disease, and this has really coined the term risk factors that has been used since this time.”

The Framingham Heart Study was also the source of the findings that linked cigarette smoking, physical activity, and blood pressure to cardiovascular disease. Predicting cardiovascular disease risk also improved with the development of the Framingham risk score, using multivariable models.

With the innovation linked to the Framingham study, it’s important to consider the future of the study as well and what should be the focus moving forward. A 6-year contract will allow for 2 studies and 2 exam visits to be funded, including 1 study with the offspring who are entering 50 years of phenotyping. “In terms of areas of opportunity for collaboration, for investigation, I think that obviously the deep phenotyping with repeated measures is a real benefit of Framingham and other longitudinal cohort studies,” said Nayer.

Nayer also illuminated new ideas in the space, including using mechanistic and perturbational studies in humans to try to test the idea that resiliency is a new marker of health. E-health and wearables are also an area of study that researchers are interested in exploring in the near future.

Bogalusa Informed Cardiac Prevention in Children, Adolescents

Ferdinand, a professor of medicine at the Tulane University School of Medicine, highlighted the Bogalusa study and all of the insights that the study provided over the course of several decades. Bogalusa, a town in Louisiana to the north of Lake Pontchartrain, is a biracial town that was the focus of the study. The study initially involved taking the blood pressures of preteens and adolescents, starting in 1972, and tying in risk factors for cardiovascular disease.

A study based on this cohort was published in 1998 in the New England Journal of Medicine,² where autopsies were performed on individuals who died of trauma aged 2 to 39 years, which identified risk factors and their association with atherosclerosis in the aorta and the coronary arteries. “Looking at both the aorta and the coronary arteries, [the researchers] saw a prevalence of increasing atherosclerosis that started from 2 to 15 years of age, 16 to 20 years of age, and then stuck with it,” Ferdinand said.

He added that these childhood risk factors led to future cardiovascular events after 35 years of follow-up. Body mass index had a stepwise increase in risk factors when compared with children who had low or normal weight. Ferdinand emphasized that determinants of cardiovascular risk were environmental and social determinants of health.

Although it is important to treat cardiovascular events when they happen, it’s also important to curb cardiovascular events by treating the source of them, including addressing obesity, Ferdinand noted. “Geography reflects the social determinants of health, where people work, live, play, and pray. And we know in the southeastern part of the United States…the rates of obesity are significantly above the national average, exceeding 20%,” he said.

Ferdinand also encouraged more research into childhood cardiovascular disease, as it may not be enough to simply study adults who present with symptoms. This includes also encouraging healthy living by families to reduce the risk of cardiovascular disease starting at a young age.

He closed by restating the most important aspects to focus on in the future, including social determinants of health, readmissions for heart failure, increased risk of stroke, food deserts, food swamps, and health equity. Instead of focusing on skin color and self-identified race, he suggested more testing for elevated lipoprotein A.

The presentations emphasized the history of preventive cardiology and how much has been achieved through the power of cohort studies but also how much is left to accomplish. The speakers’ insights demonstrated how the past can be used as a base for the building of future research in preventive cardiology.

References

1. FHS celbrating its 75th anniversary. Framingham Heart Study. Accessed August 1, 2025. https://www.framinghamheartstudy.org/fhs-celebrating-its-75th-anniversary/

2. Berenson GS, Srinivasan SR, Bao W, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med. 1998;338:1650-1656. doi:10.1056/NEJM199806043382302