The Framingham Study, diabetes mellitus and cardiovascular disease: turning back the clock

The global population of individuals with diabetes is important and rapidly growing. Because of the link between diabetes and cardiovascular disease (CVD), it is expected that diabetes will be an important driver of the future burden of CVD around the world. A connection between diabetes and CVD was suspected as earlier as in the mid 19th century. However, CVD in diabetes received less attention until the advent in the 20th century of treatments that allowed people with diabetes to live long enough to experience CVD. Since then the relationship between diabetes and CVD has been extensively investigated and characterised. The present article outlines the important contribution the Framingham Heart Study has made to the recognition of diabetes as a cardiovascular risk factor and the way in which the study has informed the association between other risk factors and CVD in the presence of diabetes, the changing pattern of the risk with time, and the quantification of CVD risk in the presence of diabetes. Through this contribution, Framingham has largely influenced our understanding of CVD in people with diabetes. Lines of investigation regarding cardiovascular health in this population are still wide open, and the Framingham Study continues to be part of this journey.