Dr. Levy, the director of the Framingham Heart Study, is joined by reporter Susan Brink for this examination of how the study--begun in 1948--helped unravel the mysteries of cardiovascular disease.

A Change of Heart is a detailed account of the revolutionary Framingham Heart study — which, over the years, has provided conclusive evidence that cardiovascular disease is largely the result of measurable and modifiable risk factors. First begun in 1948, not long after Franklin Delano Roosevelt succumbed to a massive stroke, the study of over 5,000 citizens of Framingham, Massachusetts, changed the course of medical history. The lessons learned in Framingham allow each of us to control our risk of heart disease and stroke, two of the leading causes of death in the United States. Here is a clear-eyed and intriguing assessment of the achievements of this study and of its continuing importance to our health today.

This report considers the biological and behavioral mechanisms that may underlie the pathogenicity of tobacco smoke. Many Surgeon General's reports have considered research findings on mechanisms in assessing the biological plausibility of associations observed in epidemiologic studies. Mechanisms of disease are important because they may provide plausibility, which is one of the guideline criteria for assessing evidence on causation. This report specifically reviews the evidence on the potential mechanisms by which smoking causes diseases and considers whether a mechanism is likely to be operative in the production of human disease by tobacco smoke. This evidence is relevant to understanding how smoking causes disease, to identifying those who may be particularly susceptible, and to assessing the potential risks of tobacco products.

Almost two decades ago, Drs. Meyer Friedman and Ray Rosenman de veloped the concept of the Type A coronary-prone behavior pattern and pioneered research in the area. Since then, much effort has been devoted to investigating both medical and psychosocial implications of this phenomenon by an impressive array of biomedical and behavioral scientists. On the basis of the National Heart, Lung, and Blood Institute's (NHLBI) recent Congressional mandate concerning disease prevention and control, the Division of Heart and Vascular Diseases undertook an intensive review of the existing literature in this area. The review underscored that the very nature of the concept of coronary-prone behavior requires examination by researchers from a variety of disciplines. Publication of findings in both the medical and behavioral literature, however, has created difficulties in gaining a truly com prehensive understanding of the total effort in this area. It became obvious that there was no coherent integration of information regarding the strength of the association between behaviors and disease processes (or outcomes), how be havioral factors associated with coronary heart disease were measured, the possible physiological mechanisms mediating the relationship between be havior and disease, whether intervention could be effective, and what forms of intervention appeared most promising. In short, a clear need existed to or ganize this information in a more coherent fashion so that it could be subjected to critical review by members of both the medical and behavioral scientific communities.