The natural history of congestive heart failure: the Framingham study
Abstract
The natural history of congestive heart failure was studied over a 16-year period in 5192 persons initially free of the disease. Over this period, overt evidence of congestive heart failure developed in 142 persons. In almost every five-year age group, from 30 to 62 years, the incidence rate was greater for men than for women. Although the usual etiologic precursors were found, the dominant one was clearly hypertension, which preceded failure in 75 per cent of the cases. Coronary heart disease was noted at an earlier examination in 39 per cent, but in 29 per cent of the cases it was accompanied by hypertension. Precursive rheumatic heart disease, noted in 21 per cent of cases of congestive heart failure, was accompanied by hypertension in 11 per cent. Despite modern management, congestive heart failure proved to be extremely lethal. The probability of dying within five years from onset of congestive heart failure was 62 per cent for men and 42 per cent for women.
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The Framingham heart failure criteria have been used continuously in Framingham and many other cohorts worldwide since the late 1960s.
“Since their development in the late 1960s, these criteria have been in continuous use, not only in Framingham but in multiple cohorts around the world. 57”
From The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective (2014) · cites this paper as [57]
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).”
From The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective (2014) · cites this paper as [57]
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.”
From The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective (2014) · cites this paper as [57]
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“These findings are striking, considering that the Framingham Heart Study was begun in 1948 to identify factors for CVD in the general population [28] and has now evolved to include the children and grandchildren from the original cohort, as well as two additional minority cohorts, to assess temporal trends in CVD deve…”
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- Authors
- McKee, P. A., Castelli, W. P., McNamara, P. M., & Kannel, W. B.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1971-12-23
- Volume
- 285
- Issue
- 26
- Pages
- 1441-1446
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2323862874
- Cited by
- 3,448
- References
- 19
- Citations by year
- 2026: 59 · 2025: 100 · 2024: 103 · 2023: 149 · 2022: 137 · 2021: 153 · 2020: 160 · 2019: 135 · 2018: 123 · 2017: 147 · 2016: 133 · 2015: 121 · 2014: 130 · 2013: 131 · 2012: 133
- FWCI
- 8.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Keywords
- congestive heart failure, natural history (disease), incidence, hypertension, coronary artery disease, rheumatic heart disease, sex differences, mortality, Framingham Heart Study
- MeSH terms
- Adult, Age Factors, Aged, Chronic Disease, Coronary Disease, Female, Follow-Up Studies, Health Surveys, Heart Failure, Humans, Hypertension, Male, Massachusetts, Middle Aged, Rheumatic Heart Disease, Sex Factors
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