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Cited by 1,622Cardiovascular Health and Risk FactorsHistorical and modern epidemiology studiesHealthcare Systems and Public Health

The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective

Open access
Mahmood, Syed S, Levy, Daniel, Vasan, Ramachandran S, Wang, Thomas J·2014·The Lancet
DOI 10.1016/s0140-6736(13)61752-3PMC PMC4159698
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Abstract

Summary On October 11, 2013, the Framingham Heart Study will celebrate 65 years since the examination of its first participant in 1948. During this period, the study has provided substantial insight into the epidemiology of cardiovascular disease and its risk factors. The origin of the study is closely linked to the cardiovascular health of President Franklin D. Roosevelt and his premature death from hypertensive heart disease and stroke in 1945. The present article describes the events leading to the founding of the Framingham Heart Study, and provides a brief historical overview of selected contributions from the study.

Integrity signals

Registry

Crossref · 10.1016/s0140-6736(13)61752-3

Cites

85 of 85 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 83 cited sources checked · 0 supported · 0 flagged

  • Findingcitation

    In 1971, analysis of 14 years of follow-up showed that rising baseline blood pressure increased the risk of coronary heart disease morbidity.

    “In 1971, Framingham investigators analyzed 14 years of follow-up data to demonstrate increased risk of coronary heart disease morbidity with rising baseline blood pressure.42”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [42] Finenberg, 1927, Systolic hypertension. Its relationship to atherosclerosis of the aorta and larger arteries, Am J Med Sci source

      Not checked in the free run.

  • Findingcitation

    High blood pressure also had stroke as a major consequence.

    “A few years later they noted that stroke was also a major consequence of high blood pressure.27”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Kannel, 1961, Factors of risk in the development of coronary heart disease—six year follow-up experience, Ann Intern Med source

      Not checked in the free run.

  • Findingnone given

    By the end of the 8th Framingham examination cycle in 1966, investigators had observed a rising prevalence of heart failure in the cohort.

    “By the end of the 8th Framingham examination cycle in 1966, investigators had noted a rising prevalence of heart failure in the cohort.”
    Quote in the paperSubstantial claim
  • Findingcitation

    In the 1967 Framingham risk function, the top decile compared with the lowest decile had a thirtyfold (men) to seventyfold (women) difference in coronary heart disease incidence.

    “Individuals in the top decile compared with the lowest decile had a thirty-fold (men) to seventy-fold (women) difference in the incidence of coronary heart disease.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Staessen, 1997, Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension, Lancet source

      Not checked in the free run.

  • Findingown data

    More than half of the original cohort participants were women.

    “Women comprised more than half of all participants.”
    Quote in the paperNot a substantial claim
  • May combine two claims. 21
  • Classified as probably not a substantial claim. 11

  • May combine two claims.

    Findingcitation

    The original cohort was recruited from 1948 to 1952 and included 5209 residents aged 28 to 62 years.

    “The original cohort was recruited between 1948 and 1952 and consisted of 5209 residents aged 28 to 62 years (Table 1).25”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Keys, 1989, Longevity of man: relative weight and fatness in middle age, Ann Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    The first major Framingham findings, published in 1957, defined hypertension as systolic blood pressure at least 160/95 mm Hg and found nearly a fourfold higher coronary heart disease incidence per 1000 persons among hypertensive participants.

    “The first major study findings were published in 1957, almost a decade after the initial participant was examined. Defining hypertension as a systolic blood pressure ≥160/95 mmHg, they found a nearly 4 fold increase in coronary heart disease incidence per 1000 persons among hypertensive participants.26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Oppenheimer, 2006, Profiling risk: the emergence of coronary heart disease epidemiology in the United States (1947–70), Int J Epidemiol source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Elevated systolic blood pressure predicted cerebrovascular accidents and heart failure, while diastolic pressure was not more strongly associated with these events.

    “In two other studies, investigators found that elevated systolic blood pressure was a predictor of cerebrovascular accidents as well as heart failure, and that diastolic pressure was not superiorly associated with these events. 43,44”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [43] Kannel, 1971, Systolic versus diastolic blood pressure and risk of coronary heart disease. The Framingham study, Am J Cardiol source

      Not checked in the free run.

    • cites [44] Kannel, 1970, Epidemiologic assessment of the role of blood pressure in stroke. The Framingham study, JAMA source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Hypertension was linked to more than a twofold heart failure risk, with population attributable risks of 59% in women and 39% in men because of its high prevalence.

    “On the other hand, hypertension was associated with a >2 fold increased risk of heart failure, but had a PAR of 59% (women) and 39% (men) owing to its high prevalence.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] McKee, 1971, The natural history of congestive heart failure: the Framingham study, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Hypertension came before three-quarters of heart failure cases, while coronary artery disease came before heart failure in fewer than 40% of cases.

    “Examining 16 years of observational data, the investigators found that hypertension preceded three-quarters of heart failure cases, compared with coronary artery disease, which preceded heart failure in less than 40% of cases.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [56] McNamara, 1967

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Myocardial infarction was linked to a sixfold heart failure risk, but its population attributable risk was 13% in women and 34% in men.

    “Myocardial infarction was associated with a 6-fold risk for heart failure, but the PAR was only 13% (women) and 34% (men).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] McKee, 1971, The natural history of congestive heart failure: the Framingham study, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The National Heart Act, signed on June 16, 1948, provided a $500,000 seed grant for a twenty-year epidemiological heart study and created the National Heart Institute.

    “On June 16, 1948, President Harry Truman signed into law the ‘National Heart Act.’”
    • Also stated in: § Origins of the Framingham Heart Study · plain
      “The law allocated a $500,000 seed grant for a twenty-year epidemiological heart study, and also established the National Heart Institute, which today is known as the National Heart, Lung and Blood Institute.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Bernstein, 1976, The uneasy alliance: Roosevelt, Churchill, and the atomic bomb, 1940–1945, West Polit Q source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    The study developed clinical heart failure criteria with nine major and seven minor criteria; definite heart failure required two major criteria or one major plus two minor criteria at the same time.

    “Nine ‘major’ criteria and seven ‘minor’ criteria were defined, along with one criterion that could be major or minor depending on whether the ≥4·5 Kg weight loss was due to heart failure treatment or from another possible etiology. A diagnosis of ‘Definite heart failure’ was made if the patient had two major, or one major plus two minor criteria concurrently.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [56] McNamara, 1967

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 1944, Roosevelt was diagnosed with hypertension, hypertensive heart disease, and cardiac failure.

    “The young cardiologist gave the President his first diagnosis of “hypertension, hypertensive heart disease, and cardiac failure.”5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Bruenn, 1970, Clinical notes on the illness and death of President Franklin D. Roosevelt, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Roosevelt died on April 12, 1945, at age 63 from a cerebral hemorrhage, with blood pressure 300/190 mm Hg.

    “President Roosevelt died a few weeks later on April 12, 1945, at the age of 63, from cerebral hemorrhage with a blood pressure of 300/190 mmHg.5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Bruenn, 1970, Clinical notes on the illness and death of President Franklin D. Roosevelt, Ann Intern Med source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Framingham was chosen as the study site because local physicians were enthusiastic and it was near Harvard Medical School cardiologists.

    “The state was considered ideal due to the enthusiastic response of area physicians (Figure 2), and Framingham prevailed over neighboring towns due to geographical proximity to the many cardiologists at Harvard Medical School.13”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Meadors, 1947

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The family-based cohort design was prescient given later genotyping and sequencing technologies.

    “The creation of a family-based cohort was prescient, given the emergence of new genotyping and sequencing technologies a few decades later.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The first Framingham multivariable risk function for coronary heart disease was published by Truett, Cornfield, and Kannel in 1967 and used seven risk factors: age, total cholesterol, weight, ECG abnormality, hemoglobin, cigarettes smoked, and systolic blood pressure.

    “The first attempt to create a multivariable risk function for coronary heart disease in Framingham was published by Truett, Cornfield, and Kannel in 1967.48”
    • Also stated in: § Framingham Risk Scores · plain
      “The authors proposed a multivariable logistic models with 7 risk factors: age, total cholesterol, weight, ECG abnormality, hemoglobin, cigarettes smoked, and systolic blood pressure.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Staessen, 1997, Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension, Lancet source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Roosevelt's blood pressure increased from 136/78 to 188/105 mm Hg between 1935 and 1941.

    “Between 1935 to 1941, the President experienced a gradual rise in blood pressure from 136/78 to 188/105 mm Hg.6 p213”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Bumgarner, 1994

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The 1998 Framingham risk model used risk factor categories instead of continuous values, allowing clinicians to use lookup tables for risk estimates.

    “Compared with previously published functions, the 1998 model substituted risk factor categories in the place of continuous values, which enabled clinicians to use lookup tables to obtain risk estimates.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Kannel, 1976, A general cardiovascular risk profile: the Framingham study, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisereasoning

    Framingham investigators initially debated whether to be observational or prevention-focused, and chose observational because effective interventions were scarce.

    “Framingham investigators initially struggled between whether to be an observational study to understand heart disease, or instead focus on preventing heart disease in the local population. Ultimately, given the paucity of effective interventions, the former approach won favor.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the 1940s, cardiovascular disease was the leading cause of death among Americans and accounted for about half of deaths.

    “By the 1940s, cardiovascular disease had become the number one cause of mortality among Americans, accounting for 1 in 2 deaths.4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Kannel, 1990, Bishop lecture. Contribution of the Framingham study to preventive cardiology, J Am Coll Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Randomized controlled trials showed cardiovascular benefits from lowering systolic blood pressure, leading to removal of emphasis on diastolic pressure as the main treatment target.

    “The Committee still recommended diastolic blood pressure as the basis for diagnosis and treatment of hypertension, but over the next decade, the emphasis on diastolic blood pressure as the principal treatment target was dropped after randomized controlled trials demonstrated the cardiovascular benefits of systolic blood pressure reduction.46,47”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] Moser, 1977, Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. A cooperative study, JAMA source

      Not checked in the free run.

    • cites [47] 1991, Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP), JAMA source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The population attributable risk for heart failure due to obesity was 14% in women and 11% in men, higher than for diabetes, valvular heart disease, or left ventricular hypertrophy.

    “The PAR for heart failure due to obesity was 14% in women, and 11% in men, higher than that observed for diabetes mellitus, valvular heart disease, or left ventricular hypertrophy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [78] Hubert, 1983, Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent guidelines emphasize detection of asymptomatic ventricular dysfunction (stage B heart failure) to understand and prevent overt heart failure.

    “Recent guidelines have a notable emphasis on the detection of asymptomatic ventricular dysfunction (“stage B heart failure”) as part of efforts to understand and prevent overt heart failure.61”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Wang, 2003, Natural history of asymptomatic left ventricular systolic dysfunction in the community, Circulation source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the 1971 Framingham publication, 5-year survival after heart failure diagnosis was 2 in 5 men, and 10-year survival was 1 in 5 men.

    “The original 1971 publication highlighted the poor prognosis of heart failure: only 2 in 5 men were alive 5 years after diagnosis the heart failure, and only 1 in 5 survived to 10 years.56”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] McNamara, 1967

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    By the late 1970s, the general US population weight had been increasing for several decades.

    “By the late 1970s, when William Castelli became the fourth director of the Framingham Heart Study, the general US population weight had been increasing for several decades.76”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] Castelli, 1977, HDL cholesterol and other lipids in coronary heart disease. The cooperative lipoprotein phenotyping study, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ancel Keys described elevated cholesterol levels among coronary heart disease patients.

    “Ancel Keys described elevated levels of cholesterol among coronary heart disease patients.73”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] Anitschkow, 1983, Classics in arteriosclerosis research: on experimental cholesterin steatosis and its significance in the origin of some pathological processes, Arteriosclerosis

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The 1976 risk profile variables matched the Truett study except that glucose intolerance was added and weight was removed.

    “The variables in the model mirrored those in the Truett study, except that glucose intolerance was added, and weight was dropped.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] Truett, 1967, A multivariate analysis of the risk of coronary heart disease in Framingham, J Chronic Dis source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Diabetes was associated with substantially higher risks for heart failure and hypertensive heart disease.

    “Diabetes was associated with substantially higher risks for heart failure and hypertensive heart disease.69,70”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [69] Garcia, 1974, Morbidity and mortality in diabetics in the Framingham population. Sixteen year follow-up study, Diabetes source

      Not checked in the free run.

    • cites [70] Kannel, 1974, Role of diabetes in congestive heart failure: the Framingham study, Am J Cardiol source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Survival of individuals with heart failure with preserved ejection fraction was substantially worse than those without heart failure, but better than those with systolic heart failure.

    “Survival of individuals with heart failure with preserved ejection fraction (or diastolic heart failure) was substantially worse compared with individuals without heart failure, though it was better compared with individuals with systolic heart failure.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [62] Hunt, 2005, Circulation source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cholesterol had been linked to cardiovascular disease by the early 20th century through animal and autopsy studies.

    “Cholesterol had been linked to cardiovascular disease by the early 20th century through animal and autopsy studies.71,72”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [71] Kannel, 1979, Diabetes and cardiovascular risk factors: the Framingham study, Circulation source

      Not checked in the free run.

    • cites [72] Herrick, 1912, Clinical features of sudden obstruction of the coronary arteries, J Am Med Assoc source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Critics questioned whether Framingham participants represented Americans generally and criticized the family-based approach.

    “Critics of Framingham expressed uncertainty about whether study participants represented Americans in general and about the study's family-based approach.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Caird, 1963, Heart disease in old age, Postgrad Med J source

      Not checked in the free run.

28 of 28

  • The paper relies on this without support.

    By the 1990s, widespread use of beta-blockers and ACE inhibitors altered the prognosis of heart failure.

    “By the 1990s, the widespread use of mortality-altering medications such as beta-blockers and ACE inhibitors had altered this prognosis.”

  • The paper relies on this without support.

    Diastolic heart failure is common in the community, particularly among older individuals and women.

    “Studies from other cohorts yielded consistent findings, and led to increased recognition that diastolic heart failure is common in the community, particularly among older individuals and women.”

  • The paper relies on this without support.

    Obesity co-occurs with hypertension, elevated lipids, and diabetes, and increased cardiovascular risk in obese individuals is often attributed to these co-existing risk factors.

    “As obesity occurs concomitantly with hypertension, elevated lipids, and diabetes, the increased cardiovascular risk in obese individuals is often attributed to these co-existing risk factors.”

  • The paper relies on this without support.

    Each suspected new case of stroke in Framingham was confirmed by a second examiner and through neurological consultation.

    “Each suspected new case of stroke was confirmed by a second examiner as well as through neurological consultation.”

  • The paper relies on this without support.

    Anticoagulation for individuals with atrial fibrillation became the standard of care.

    “Fortunately, such trials were performed and anticoagulation for individuals with atrial fibrillation became the standard of care.”

  • The paper relies on this without support.

    Heart failure diagnoses in Framingham have been prospectively adjudicated using a single set of diagnostic criteria since the 1960s.

    “Because heart failure diagnoses in Framingham have been prospectively adjudicated using a single set of diagnostic criteria since the 1960s, the study has been a valuable source of information regarding long-term trends in the epidemiology of the condition.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The Framingham Heart Study has demonstrated that hypertension, coronary artery disease, cardiac hypertension and diabetes are cardiovascular risk factors associated with the future development of heart failure.

    “Over its 74-year length, the Framingham Heart Study has demonstrated that hypertension, coronary artery disease, cardiac hypertension and diabetes are cardiovascular risk factors associated with the future development of heart failure [2,3].”

    From Recent Experimental Studies of Maternal Obesity, Diabetes during Pregnancy and the Developmental Origins of Cardiovascular Disease (2022) · cites this paper as [2]

    The sections on heart-failure epidemiology and metabolic risk factors report that hypertension and coronary artery disease preceded heart failure, and that diabetes was associated with substantially higher heart-failure risk. The paper does not identify “cardiac hypertension” as a separate risk factor; it mentions hypertensive heart disease as an outcome associated with diabetes. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Biobank efforts pioneered in Framingham and DeCODE now encompass a growing inventory of national cohorts in North America, Europe, Asia and beyond.

    “These biobank efforts, pioneered in studies such as the Framingham Cohort70 and the efforts of DeCODE in Iceland71,72, now encompass a growing inventory of national cohorts in North America, Europe, Asia and beyond73–76.”

    From A brief history of human disease genetics (2020) · cites this paper as [70]

  • The iAge gene expression signature was significantly associated with all-cause mortality in the Framingham Heart Study after adjustment for multiple mortality-related covariates.

    “We observed that the iAge gene signature was significantly associated with all-cause mortality following adjustment to multiple covariates associated with mortality, including age, sex, smoking, cholesterol levels, blood pressure, diabetes and existence of a cardiovascular disease (P = 0.02, Cox proportional hazards model, n = 2,290).”

    From An inflammatory aging clock (iAge) based on deep learning tracks multimorbidity, immunosenescence, frailty and cardiovascular aging (2021) · cites this paper as [36]

Cites

Flagged first, then by citations

1 of the 86 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. 1948, 80th US Congress, 2nd Session, Senate Report 2215, The National Heart Act, 481, 62
  2. Keys, 1960, Serum cholesterol and relative body weight of coronary patients in different populations, Circulation, 22, 1091, 10.1161/01.cir.22.6.1091 · DOI · Paper page

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Related

Authors
Mahmood, S. S., Levy, D., Vasan, R. S., & Wang, T. J.
Affiliations
  • Harvard University (US)
  • National Institutes of Health (US)
  • Boston University (US)
  • Vanderbilt University (US)
Corresponding author
Wang, Thomas J
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2014-03
Volume
383
Issue
9921
Pages
999-1008
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(13)61752-3
PMC
PMC4159698
OpenAlex
W2030322782
Semantic Scholar
a856c8df2f6656167328ccc091cb374a1d152f60
Cited by
1,622
References
86
Citations by year
2026: 98 · 2025: 172 · 2024: 179 · 2023: 175 · 2022: 181 · 2021: 200 · 2020: 149 · 2019: 146 · 2018: 100 · 2017: 89 · 2016: 55 · 2015: 50 · 2014: 27
FWCI
7.50
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
NIH (N01-HC-25195)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Social Sciences › Sociology and Political Science › Historical and modern epidemiology studies
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords
Framingham Heart Study, cardiovascular disease epidemiology, cardiovascular risk factors, Franklin D. Roosevelt, hypertensive heart disease, stroke
MeSH terms
Cardiovascular Diseases, Epidemiology, Humans, Longitudinal Studies, Massachusetts, Research Support as Topic, Risk Factors, History, 20th Century, History, 21st Century

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