Talk:Framingham Heart Study

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Criticism

Although framinghamheartstudy.org maintains that increased levels of total serum cholesterol increase the risk of coronary heart disease regardless of age, their own data suggest that after 50 years of age there is no increased overall mortality with either high or low serum cholesterol levels. https://jamanetwork.com/journals/jama/article-abstract/365739

"Many studies and articles criticise the Framingham study. As evidence, the following quote is used: "In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people's serum cholesterol...we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories weighed the least and were the most physically active." Dr William Castelli 1992 (Director of the Framingham study). "

criticse on what bases? presente as evidence of what? — Preceding unsigned comment added by Midgley (talk • contribs) 15:39, 25 January 2006 (UTC)

That's not criticism. It sounds like an unexpected result of the study. Does it come with a proper source, e.g. journal article or newspaper report? JFW | T@lk 16:19, 25 January 2006 (UTC)

The source is: Castelli, William, "Concerning the Possibility of a Nut. . ." Archives of Internal Medicine, Jul 1992, 152:(7):1371-1372

http://archinte.ama-assn.org/cgi/content/summary/152/7/1371 -- maybe this helps? —Preceding unsigned comment added by 84.248.113.186 (talk) 19:54, 29 March 2009 (UTC)

However for some reason the abstracts on pubmed and Archives of internal medicine don't seem to have any text!? [1] [2] [3]

Anyway, many articles do criticize it for the reason that it goes against established thinking. I'll see if I can find a reference of a critical article. Turgonml 14:44, 13 November 2007 (UTC)

Seriously, I would love for a definitive answer on this Dr. Castelli quote, which I have seen repeated in many, many places. But I can't find a single official source confirming or refuting it. I guess this guy is still alive so it would be great if we could find out directly from him, but I can't find out any contact information. Given how controversial this topic is I can't believe this hasn't been settled conclusively yet. --WayneMokane (talk) 01:45, 4 April 2008 (UTC)

There is a citation given in article is indeed given as Castelli, William, Arch Int Med, Jul 1992, 152:7:1371-1372. I'll check on it the next time I go to the library ind put the statement in the article if the attribution is accurate. If so this would be a rather important inclusion to say the least. --WayneMokane (talk) 19:24, 27 June 2008 (UTC)

I found a few more references to this quote, one on each side of the "was it taken out of context" debate. See [4] and [5]. —Preceding unsigned comment added by WayneMokane (talk • contribs) 20:47, 27 June 2008 (UTC)

Please expand this article

Archives of Internal Medicine, Volume 152, July 1992, pp. 1371-2

On the possibility of a nut

The findings reported by Fraser et al1 from the Adventist Health Study revive our interest in looking for data from prospective studies that show diet factors associated with favorable blood cholesterol or lipoprotein levels in free-living populations eventually lead to lower rates of coronary heart disease (CHD). Most of what we know about the effects of diet factors, particularly the saturation of fat and cholesterol, on serum lipid parameters derives from metabolic ward-type studies.2,3 Alas, such findings, within a cohort studied over time have been disappointing, indeed the findings have been contradictory. For example, in Framingham, Mass, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower the person's serum cholesterol. The opposite of what one saw in the 26 metabolic ward studies, the opposite of what the equations provided by Hegsted et al2 and Keys et al3 would predict. Only the international comparisons showed that the world could be lined up on cholesterol intake or saturated fat intake, and it would correlate with the rate of CHD.4 Of course, since these countries differed in many other ways, the possibility that some unidentified factor might explain the rate of CHD, loomed in one's thoughts. Eventually, diet intervention trials were done, and where the follow-up got out beyond 3 years, they all show the same thing. The larger the percentage fall in cholesterol, the larger the percentage fall in CHD.5

In view of this, this study fails to describe a relationship of those traditional dietary constituents, saturated fat and cholesterol, known to have an adverse effect on blood lip-ids, and thereby, on the subsequent development of coronary disease end points. Only the Western Electric study6 has shown dietary cholesterol to be related to the later development of CHD in a population study. However, the authors of this Adventist study did show a slight increase in definite nonfatal myocardial infarction with eating cheese one to two times per week (RR = 1.97; 95% confidence interval, 1.27 to 3.04) and, in men, a relationship of eating beef to fatal CHD. Whole wheat bread, thank goodness, lowered the nonfatal coronary disease rate.

The big finding was nuts. Nuts, eaten five or more times a week, apparently independently (Cox proportional hazard model analysis adjusted by age, sex, smoking, exercise, relative weight, and high blood pressure) lowered the coronary fatal and nonfatal end points in half. But these are the Seventh-Day Adventists who already have a seventh of our heart attack rate, who live 7 years longer than we do. How could you cut this rate even lower, in half? Is this the first article showing a dramatic fall in coronary disease rates in men and women who are already at low risk?

The first reaction of a population watcher is that there just has to be some other factor related to nut ingestion confounding this relationship. The two factors that jump to mind are exercise and weight. In Framingham, for example, we found that the people who ate the most cholesterol, ate the most saturated fat, ate the most calories, weighed the least, and were the most physically active. This article showed that the people who eat the most nuts weigh the least. However, in the Cox model, neither exercise nor weight explained the impact on coronary disease. As to what other factors associated with nut eating explain the benefit, the authors give us a preview of a feeding trial, using walnuts, that at least shows a favorable change in the blood lipids eating nuts. Is this due to the polyunsaturated or monounsaturated fat in nuts? Is it some exotic fiber component? Hopefully, this anecdote will allay speculation about some other exotic confounder like television watching, nose-picking, or any myriad number of factors not routinely measured in this study.

I suppose that the ARCHIVES will be bombarded by the usual letters about an article such as this by those cheerful folk who will want to know if the fall in coronary death rate in the nut eaters was offset by an increase in accidental, violent, or suicidal death. Perhaps there was a social price to pay, at least from the peanuts that, after all, are legumes.

Should dietitians everywhere tremble? Has the magic bullet arrived? Is it the humble nut? Should fat people eat fat-rich nuts to lose weight and atherosclerosis, or do nuts only work in vegetarians? Should nuts replace oat bran as the shield that I can load up on each day which will let those hot dogs just bounce right off my chest, no trouble.

Will this article affect the stock market sending the lipid-drugs reeling when that well-balanced report appears in the Wall Street Journal? So many questions, so little time. In the meantime, hold the cheese, I will have my nuts (walnuts?) on whole wheat, please.

William P. Castelli, MD.

Framingham Heart Study National Heart, Lung, and Blood Institute 5 Thurber St Framingham, MA 01701

References

1. Fraser GE, Sabato J, Beeson WL, Strahan TM. A possible protective effect of nut consumption on risk of coronary heart disease; The Adventist Health Study. Arch Intern Med. 1992;152:1416-1424.

2. Hegsted DM, McCandy RB, Myer Ml, Stare FJ. Quantitative effects of dietary fat on serum cholesterol in man. Am J Clin Nutr. 1965;17:281-295.

3. Keys A, Anderson JT, Crande F. Prediction of serum cholesterol responses of men to changes in fats in the diet. Lancet, 1957; 2:959-966.

4. Keys A. Coronary heart disease in seven countries. Circulation. 1970;41(suppl 1):1-211.

5. Castelli W. Cholesterol and lipids in the risk of coronary artery disease: The Framingham Heart Study. Can J Cardiol. 1988;4(suppl A):5A-10A.

6. Stamler J, Shekelle R. Dietary cholesterol and human coronary heart disease. Arch Pathol Lab Med. 1988;112:1032-1040 The article describes the Study in general, but should also present the major insights and recommendations that have come out of the Study over the years, including insights that have reversed or extended previous insights. David (talk) 10:52, 30 June 2008 (UTC)

Something to consider adding

http://www.sciencedaily.com/releases/2009/01/090106181731.htm

Traditional Risk Assessment Tools Do Not Accurately Predict Coronary Heart Disease

futurebird (talk) 20:27, 14 January 2009 (UTC)

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