The Framingham Study: historical insight on the impact of cardiovascular risk factors in men versus women.

The Framingham Study has investigated the evolution of cardiovascular disease (CVD) over five decades in a general population sample of men and women. This study has provided valuable insight into the prevalence, incidence, prognosis, and predisposing risk factors for CVD in women compared to men. Women were found to outlive men and to experience fewer atherosclerotic CVD events, lagging behind men in incidence by 10-20 years. However, this gap in incidence closed with advancing age and in the elderly, CVD became the leading cause of death in women as well as men. Comparing the life-time risk of coronary heart disease (CHD) with that of breast cancer in the Framingham cohort indicated a threefold greater chance of having a CHD event (24-32%) than breast cancer (7-12.5%). Thus, CVD is not a minor problem in women, and vigorous preventive measures are warranted at all ages. There is a need for particular attention to glucose intolerance, abdominal obesity, and blood lipids, and a need for a great sense of urgency when hypertension is associated with diabetes or promotes left ventricular hypertrophy.