A14 Consent Forms

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The Framingham Heartbeat
Published by The Framingham Heart Study in collaboration with Boston University
Funded by the National Heart, Lung, and Blood Institute
www.framinghamheartstudy.org

William B. Kannel, MD,
Pioneer in Cardiovascular Epidemiology, 1923-2011

William B. Kannel, MD, Director of the Framingham Heart Study, 1966-1979

Dr. Kannel was active in the field of cardiovascular epidemiology for
more than 60 years, enabling the Framingham Heart Study to become
a leader in this field of research. He joined the Heart Study in 1950.
In 1966, he became the NIH Director of the Heart Study, replacing Dr.
Thomas R. Dawber, the original architect of the study, serving in this capacity until 1979. Between 1979 and 1987, as Professor of Medicine and
Chair of the Preventive Medicine Section at Boston University School
of Medicine, he served as the Principal Investigator of the Framingham
Study. Subsequently, he continued work as the senior-most investigator at the Heart Study until his recent illness curtailed those efforts.
The Framingham Study was acknowledged to be among the top ten
medical advances in the last century in several reports, in no small
measure attributable to Dr. Kannel’s scientific contributions. He published over 600 medical articles, numerous editorials and book chapters in premier texts. His work at the Framingham Study established
the utility of population-based research for seeking out correctable
predisposing factors for cardiovascular disease (CVD), putting prevention at the forefront of cardiology. Dr. Kannel coined the medical term
“risk factor” in 1961 in a landmark publication in the Annals of Internal Medicine, and promoted the concept that CVD is multifactorial
in origin. He promoted the notion of combining information about
multiple risk factors mathematically to estimate risk of CVD (the Fram-

Winter 2012

ingham risk score). His research established the importance of distinguishing between usual (average in the population) and optimal risk
factor levels. In several seminal papers he dispelled the concept that
rising systolic blood pressure in older people is a harmless finding. Data
collected by Dr. Kannel and his colleagues at the Heart Study in the
late 1950s and early 1960s resulted in the reporting of population incidence of CVD at a time when only mortality statistics were available.
In 1971 (approximately three decades before the completion of the human genome project), Dr. Kannel began the second generation study
called the Framingham Offspring Study that quantified the hazard of
a family history of CVD based on observations on parents and their
offspring. His research on the two generations of Study participants
provided insights on mechanisms of atherogenesis and stimulated
national campaigns against smoking, high cholesterol, high blood
pressure, and obesity. He warned in 1985 of the lack of efficacy and
danger of estrogen replacement for preventing CVD. In 2008, along
with his colleagues, he formulated the Framingham risk score, to enable primary care physicians to pull together risk factor information to assess the risk of heart attacks, heart failure, and strokes. Dr.
Kannel influenced several generations of physicians and was one
of a handful of “founding fathers” of preventive cardiology. He also
trained scores of postdoctoral research fellows at the Heart Study who
are following in his footsteps. In the various articles of this newsletter you may see the continuing influences of Dr. Kannel’s work. Y
William B. Kannel, MD, died August 20, 2011. He is survived by his
wife, four children, 12 grandchildren and 23 great-grandchildren.
A William B. Kannel Legacy Fund has been established at Boston
University to support projects at the Framingham Heart Study. Alternatively, contributions may be made in Dr. Kannel’s memory to
the Friends of the Framingham Heart Study. Contributions to either
fund may be sent to 73 Mt. Wayte Ave., Suite 2, Framingham, MA

The Legacy Continues in the 9th Exam for Offspring
(Generation 2).
The Framingham Heart Study Offspring Cohort participants, first organized by Dr. Kannel in 1971, have been famously responsive to the
programs of the Heart Study over the years. We are scheduling now
for the 9th Exam. Many of the research tests are repeats from past
exams. There will be some new tests as well, including a motion monitor and a 24 hour urine collection. The recruitment team is eager to
schedule participants for this new exam. In fact, you may have already received a call! Especially if you live out of town and are planning to visit the Framingham area, please contact your coordinator,
Maureen, at 800-536-4143 right away for a morning appointment. Y

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“Induced Pluripotent Stem Cell” Progress Notes.
We are happy to report that most attendees at the current FHS ex-

Body Chemistry Studied At FHS From 24-Hour Urine
Collection.

amination cycle (approximately 1000 so far) have agreed to al-

Researchers at FHS look for new ways to learn about health and disease.

low some of their white blood cells be used in “induced pluripotent
stem cell” research. The FHS laboratory sends white cell samples
collected at the examination to our colleagues and scientific col-

We measure the anatomy by height and weight and with CT and MRI
scans. We measure functions with electrocardiograms, physical activity

laborators at a stem cell laboratory at Harvard. The researchers cre-

monitors and grip strength tests. Genetic effects are found through DNA

ate cells known as iPS (induced pluripotent stem) cells. New tech-

analyses. Now, more and more, scientists are learning about many in-

nology has enabled scientists to “reprogram” cells, sending them back

dividual differences in body chemistry with better and better laboratory

along their developmental path to an earlier stage. From the result-

tools. The two fluids commonly studied by chemical analysis at FHS

ing, more primitive iPS cells, many other cell types can be developed
and their functioning can be studied. Since these are not cells that are
developed from human embryos cells, their use is not controversial.

are blood and urine. Each sample contains large numbers of biological
materials that are clues to how the complex human body is working.

Your DNA is in nearly every type of cell in your body. DNA ex-

At the current Offspring and Omni Group 1 exam cycle, participants

presses itself in different ways in different tissues, which is why heart

are asked to use a kit at home to collect a 24-hour urine sample. Then a

cells act like heart cells and liver cells act like liver cells. By tak-

small sample from the collection is mailed to a lab for detailed analysis

ing a sample of your white blood cells, we can change them into
iPS cells that genetically match you, and then further develop them
to imitate your liver, heart, and other cells.

Furthermore, we can

study these FHS iPS cells to see how those of one person differ from

and another sample is stored in the FHS lab for future use. We expect
to learn from the various biochemical measurements in urine and how
this relates to overall health and disease. Many FHS participants in the

those of others. We can test drugs in these cells to see how they re-

Offspring and Omni Group 1 cohorts have already provided 24-urine

spond. We can study disease progression in these cells in a labora-

samples. The kits are easy to use. We hope many others will agree to

tory setting. We hope this research will be a step in the process of

participate in this way, in the coming two years. If you were too busy last

better understanding and curing heart, lung and blood diseases. Y

year to accept or use the 24-urine kit at the time of your FHS examina-

Easy does it. Try the FHS
“Motion Detector”.

tion, please consider doing it now. You may contact Barbara Inglese at
(508) 935-3451 or (800) 601-3582, to order a new kit or get instructions

As you know, exercise is a part

on use and mailing of a kit you already received. As always, the more

of healthy living. Dr. Kannel and

FHS individuals who participate in an FHS project, the more clearly

other FHS researchers first studied

we can define the complex patterns that effect disease and health. Y

physical activity from answers on
questionnaires.

Now Offspring

and Omni participants are being
asked to wear an “Actical” physical activity monitor after their ex-

The Annual Dawber Memorial Scholarship Contest.
In memory of Dr. Thomas R. Dawber, Director of the Framingham

ams at the FHS research clinic.

Heart Study from 1949 to 1966, the Friends of the Framingham Heart

The monitor is as small as a wrist

Study awarded a $1,000 scholarship last year to Reilly Garrett for his

watch and is worn on a fabric

prize-winning essay. The 2012 competition for the Dawber award is

belt loosely around the waist. As

open to all children of Framingham Heart Study participants who will

you move, it records your activity. After 8 days, you mail it back to
FHS in a prepaid envelope provided to you. The little monitors are
quite costly, but FHS can use them again and again after the infor-

be graduating from high school in the spring of 2012 and going on
to college. The winning essay will be selected by the Board of the

mation they record is transferred to an FHS computer. We have al-

Friends. Essays entitled “What It Means to be a Participant in Medi-

ready downloaded over 3500 recordings from FHS participants in

cal Research” should be sent as a Word document of a minimum of

the Third Generation, Omni Group 2, Offspring and Omni Group1.

1,000 words attached to an e-mail to Greta Lee Splansky at gretalee@
bu.edu, no later than April 3, 2012. The e-mail message should in-

If the week following your clinic exam is not the best time for
you to wear the monitor, simply ask for it to be sent to you at a
date that will be more convenient. Your physical activity recording will become a part of many FHS research projects in the
years to come. We thank you again for your participation.

2

Y

clude college and career plans after graduation, as well as name,
address, and phone number. (If you do not receive an e-mail acknowledging receipt of your essay, please call Greta Lee Splansky at
508-935-3418.) The winner will be notified by the end of May of 2012
and will be invited to meet the Friends and receive the award. Y

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FHS Medical Record Department.

THE FRAMINGHAM HEART STUDY EXAMINES

FHS medical records contain all the participants’ exams and outside

CHANGES IN BRAIN AND BONE STRUCTURE

medical record information compiled and collected for 63 years. The
medical record department is responsible for maintaining, preserving,

Offspring Exam 9 / Omni Exam 4 Callback

and protecting the confidentiality of these records. The medical record

The Neurology research group at the Framingham Heart Study (FHS)

department obtains and processes participant medical records neces-

has in the past two years collaborated with researchers from all over the

sary for physician review and ancillary and special studies. We also re-

world to identify over 15 new genes and several new biomarkers as-

spond to participants and their healthcare provider’s requests for medical
record information and assist researchers in medical record review. Y

sociated with brain aging, Alzheimer’s disease, and stroke. We are particularly interested in understanding how brain structure changes over
time in persons who remain well as they grow older compared to those
who go on to develop a neurological disease. Since 1992, more than
5000 FHS participants have undergone one or more brain MRI scans
and completed tests of memory, planning, and other cognitive abilities.
In early 2012, we are beginning an additional round of brain MRI
and cognitive testing, as a callback examination of the participants
attending Offspring Exam 9 and Omni Group 1 Exam 4. This round
of MRI will include a study of subtle changes within the white matter

MEMBERS OF THE FHS MEDICAL RECORDS STAFF (FRONT ROW-LEFT TO RIGHT):
Lindsey Witnauer, and Rajeswari Reddy. BACK ROW (LEFT TO RIGHT): Susan Chau,
Lynne McDonald, Donna Chandler.

of the brain using a technique called diffusion tensor imaging (DTI).

Since 1988, FHS participants have had bone mineral density (BMD)
measured as part of the Framingham Osteoporosis Study (FOS) study.
The FOS study goal is to measure the density and structure of your bones
to see how well these measures predict your risk for future fracture. The
FOS will be collaborating with the Neurology group to repeat bone mineral density (BMD) studies during the callback examination. The current
FOS bone exam will include a new technology, high resolution peripheral quantitative tomography (HR-pQCT), to measure bone microarchiMEMBERS OF FHS HEALTH UPDATE AND STROKE STAFF (LEFT TO RIGHT): Lois Abel,
Deb Foulkes, Mary Ann Crossen and Crystal Holmes.

How Does Medical Information Get Verified
And Coded For FHS Research?
The Framingham Heart Study Review Department coordinates and
oversees the review of cardiovascular events and deaths within the par-

tecture of the lower arm and leg. HR-pQCT creates 3-D images of bone
using a weak radiation dose and provides information on very fine bone
structure. We will also measure bone mineral density the way we have
done in the past. Mary Hogan, our certified bone density technician,
will once again be working with you to obtain these measurements.

ticipant population. We obtain reports of participants’ medical histories
from their Heart Study examinations, and from Medical History Update

For

more

information

forms completed by mail or telephone every two years. With participant

MRI

and/or

consent, the Medical Records Department obtains records for medical

Farese at 508-935-3488, 800-248-0409 or [email protected] Y

brain

about

donation

the

cognitive

program,

please

testing

brain

contact

Linda

encounters from healthcare providers. These records are carefully reviewed by a panel of Framingham Heart Study physicians and coded
as specific events, such as myocardial infarctions and strokes. The
event codes are added to the Framingham database for further study.

Remember: Framingham Heart Study examinations
are designed for research.
They do not replace
your regular check-ups with your own doctor(s)!

Dr. Kannel taught us that good research at the FHS starts with good
data. We greatly appreciate the information provided by our participants at Heart Study examinations and on Medical History Updates. Y

3

Trustees of Boston University
National Heart, Lung, and Blood Institute
Framingham Heart Study

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RETURN SERVICE  REQUESTED

OMNI Generation 1, Have You Scheduled Your
Current Exam?
We are calling Omni Group 1 participants for their 4th clinic exam.
Each of you holds unique pieces of the Framingham Heart Study research puzzles. Please help increase the research value of your early
tests by repeating the exam now. Most of the tests this time are similar
to those of previous exams. New tests include a slight scraping of the
inside of the cheek to obtain DNA cells, an activity monitor to wear for
a week and a 24 hour urine test (these last two are ancillary studies).
If you live out of state (or in another country) and plan to visit Massachusetts, please let us know and we will try to accommodate
your schedule. Appointments are in the mornings, Monday through
Friday, and take 4 hours or less. If you cannot make it this time,
please call us at 888-689-1682 to update your medical records.
In just a few minutes you can give us extremely useful data. Y

Find out more about the Framingham Heart Study
on our website, at www.framinghamheartstudy.org.
The website is designed to serve the FHS participants, the community of researchers and the general public. We welcome your feedback and suggestions for improving the FHS website. If you have
ideas for the website, please send them to the editor, Heather Arruda, by email ([email protected]) or by phone to 617-414-1244.

TO CONTACT US
Receptionist: 508-872-6562 or 800-854-7582
Marian Bellwood: Original Cohort Coordinator and
Recruitment Supervisor:
508-935-3429 or 800-451-0260. [email protected]
Maureen Valentino: Offspring, New Offspring
Spouse and Third Generation Coordinator:
508-935-3417 or 800-536-4143. [email protected]
Paulina Drummond: Omni Coordinator:
508-935-3485 or 888-689-1682. [email protected]
Linda Farese: Brain Donation Program Coordinator:
508-935-3488 or 800-248-0409. [email protected]