Stuff You Should Know - How the Framingham Heart Study Works

Episode Date: March 22, 2018

In the 1940s, a tiny town outside Boston volunteered to be test subjects in a study that would become one of the longest and broadest in the history of medicine. Originally designed to study heart disease, it's revealed things about plenty else too: everything from evolution to selecting a spouse. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

On the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s.

We lived it, and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. Do you ever think to yourself, what advice would Lance Bass

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Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts. Hello, Colorado. The state's so nice, we're playing there twice. That's right. Two days in a row, Chuck. We added a second show to our Gothic Theater tour.

That's right. We're gonna be there June 7th and June 28th now. The 28th is sold out, but one of those weird cases where you go see the first show, you were actually late buying tickets. Right, we're also gonna be in Boston April 4th, D.C. April 5th. We're gonna be in St. Louis on May 22nd,

and Cleveland on May 23rd. And then of course, we're gonna wrap this summer up on June 27th to 28th at the Gothic Theater in Colorado. So go to sysklive.com for all of your information and ticket needs. Welcome to Stuff You Should Know from HowStuffWorks.com. Hey, and welcome to the podcast.

I'm Josh Clark. There's Charles W. Chuck Bryant. There's guest producer Noel. All of nature, wild and free. This is where you long to be. Stuff you should know. So let's go ahead and admit that we just did a rare retake of like the first four minutes of the show.

Yeah, and I still reuse the Madonna lyric joke. That's fine, but do we have to recreate the rest of the previous four minutes? No, I don't think so. I think we should just kind of let it flow. I was just, I was saying to myself, by God, that Madonna joke's getting in there. All right, well, maybe just a quick recap.

Noel's dressed up and looks great. He's, it's cause he's a snappy dresser. We mispronounced words in the UK and got laughed at. Right. And now we're talking about the Framingham Heart Study. That's right, which we, I don't know what podcast it was on, but years ago we called it the Farmington Heart Study. Every time we said it, we said Farmington.

Did we really? Yeah, you don't remember that? No, I mean, that definitely sounds like us, but I don't remember it. Yeah, yeah, that's why I made that joke when you first came in about the Farmington Heart Study. Oh, okay. Yeah, we said, it was years ago.

It was one of our earlier couple of years and we said the Farmington Heart Study, probably 12 times. Yeah, back in the day, the standards used to be as had lower. Yeah. Cause we were low hanging fruit podcast. It was us, Zyra Glass, it was Ricky Gervais and Jesse Thorn.

And then Adam Curry was out there somewhere. Sure, and probably Adam Corolla. Sure, oh yeah. No, but no one else, we had, there were eight podcasts. That was it. That was all you had to choose from. So you better like at least one of them. Do you know how many there are now?

I just saw today. No, do you, like you have an actual number? Well, I mean, it's an even number. So it's probably not exact, but the latest hot pod newsletter said that there are roughly 350,000 podcasts. Oh my God, that's nuts. Wow.

I know. Man alive, that's pretty impressive. And probably only like 500 of those are good. Well, we went from, that was mean. We went from eight to 350,000. And how many years? 10? Yeah, we're still hanging strong.

We are, that's great. That's what happens when you say things like farming 10, 12 times. Look at that, Ricky Gervais, he's long gone. Yeah, he pronounced everything perfectly. That guy's washed up now. Yep. So the reason we're talking about framing him,

which by the way, yeah, yeah, it's gonna be tough to say it the same way every time, but Framingham is a city of Massachusetts. I don't get the Framingham as opposed to framing him. Yeah. Okay. Yeah, the H is a hard H, or a soft H, like. Whereas if this were in Scotland,

they would just say, for all of them. You're right. Which is again, why we were laughed at in Manchester. No, that's Germany, sorry. Right, which is landlocked. So again, we're talking about framing him, Massachusetts. It's a very small town. These days in 2017, I think the census,

well the population estimate was something like 70,000 residents, not a huge town. I think that qualifies as a small dinky town still. Yeah, but it's a suburb of Boston, which is a huge metropolis. Sure it is. But it is, aside from being a suburb of Boston, it is in its own right, an internationally renowned

tiny town. Sure. Not because it's like a place where the circus used to hang out during the winter, or because they have some amazing kind of fudge, right? Farmingham, Massachusetts is on the map because that town, back in the day, actually two times over,

that town decided that they were going to present themselves as test subjects, study participants for some of the most important studies ever carried out in the history of medicine. Yeah, one of the largest and certainly most influential longitudinal studies ever performed in medicine. Yeah, it's called the Farmingham Heart Study. The framing him?

Oh my God. Was that an accident? Yes. Oh boy. The framing him Heart Study. Yeah, which, you know, we've had challenges as has the medical community and research community throughout study history of being frustrated

with like bad studies and poor sample sizes. This one is really set the standard. Yeah, it's the gold standard for anything that has anything to do with studying cardiovascular disease and as we'll see it basically is everything we know, you and I, just Joe Schmo walking around on the street know about cardiovascular disease basically came out of this study.

Yeah. And even before that, there was another study that the town participated in that helped lick tuberculosis. Gross. Which was appropriate because, you know, framing him, yeah, I got it right, is in Massachusetts, which is part of New England, which was part of the vampire panic area,

which as you remember was the result of tuberculosis. So it was appropriate that that little town contributed to humanity in that way as well. Yes, so should we hop in the way back machine? Oh yes. All right, let's set the dial. Let's load up the flux capacitor with Miller heavy beer and banana peels.

Miller heavy. Yeah, that's what he used. Nice. I think so. Yeah, this is Miller Highlife. Oh, okay. That's at the end with the more modern version Right, right.

Of the DeLorean. Yeah, I think he used some sort of plasma waste incinerator. Mm-hmm. Yeah. So let's set the dials for the World War II era. We're not gonna be super specific here. No.

Sometimes we roll the dice in the way back machine. Let's see what happens. Just say spit us out anytime in the 1940s. Not in Europe or the South Pacific. That's right. So in the 1940s, here was a scene in the USA, and I guess all over the world, is we did not know a lot about,

and all this stuff seems so second nature now, and like, duh, about heart disease. But we didn't know a lot about heart disease back then, and it was sort of just accepted that once you reach a certain age, like, yeah, your heart just may take you out. Nothing we can do about it. Right.

Might as well not research it, and there's certainly no preventative medicines for you to ensure that health. No, certainly not. Like, they could try to treat it or whatever, but most of the time, once you came down with one of the cardiovascular diseases, you were a goner.

Yeah, 44% in 1948, 40% of US deaths were due to CBD. Right, and so there was a confounding factor that led to this huge increase. There were actually two of them. One is, as far as percentages go, the cardiovascular disease deaths lurched forward in the early mid 20th century, because what used to be the big killers,

which were infectious diseases, which we now consider highly treatable, they used to kill everybody, right? And as we started to treat them, thanks to the discovery and use of penicillin and antibiotics, those things fell into the background, and by extension, or by proxy, the cardiovascular disease was basically

bare naked out there, statistics-wise. Suddenly, something that was just kind of like a secondary problem was now the leading cause of death in the United States, and in the West, I believe. Yeah, because I guess people were living, routinely living into their 50s and 60s, maybe for the first time, I don't know. Yeah, and they were saying,

my God, I'm so glad I get these extra couple decades of eating raw steak and smoking cigarettes at the dinner table. Gross, that is so nasty. It's a true story, though. I saw my grandpa do it with my own eyes. Oh, smoke at the table? No, actually, my grandpa was one of the,

he went the other way. He was subscriber number three to Prevention Magazine. Oh, really? Yeah, into coffee enemas and all sorts of weird stuff. He was big time, healthy guy. Is that what led your dad to become the herbal Elvis? I think that that had some, it had to have had something to do with it, for sure.

Luckily, my dad didn't carry on the family tradition of coffee enemas down to me. So, all right, so by 1948, 44% of deaths are cardiovascular. Everyone's dying now from their heart because they're living longer, because they're not dying of TB in their 30s and 40s.

And then the second big thing that happened that you teased was President Roosevelt started to get really, he got cardiovascular disease. He started to get really high blood pressure. This was compounded by, now we understand that stress and anxiety can compound these things.

And he certainly had no shortage of that as president. And Winston Churchill of all people, when he says, he seems to be a very tired man, if Winston Churchill was saying that, then you're in trouble. Yeah, because he wasn't the picture of health. No, he certainly wasn't. But apparently FDR made him look like he was fresh as a daisy.

I guess so. So FDR had high blood pressure when he went into the White House to begin with. But by the time 1945 rolled around, right after the Yalta Conference where they divided Europe up between Great Britain, the United States, and Russia, the Soviet Union, right?

He died a couple of weeks after that at age 63. He had a stroke from hypertension, which is another word for high blood pressure. And boy, oh boy, did he have high blood pressure. Like off the charts, Chuck. Yeah, when he died, he had 300 over 190. One more time. 300 over 190.

So I went and looked that up. I'm like, even without looking it up, I know that's high. But how high is it? So ideal is between 90 over 60 and 120 over 80. That's ideal blood pressure. Anything over 180 over 120 is what's called a hypertensive crisis. And the chart tells you to go to your doctor immediately

for that, if you can have anything over 180 over 120. FDR had 300 over 190. Yeah, and I mean, his doctor said, I predict, he's a very sick man, I predict he will be dead within a few months and he was running all the money. Right, Churchill's doctor. Yeah. FDR's own doctor was like, here, take this digitalist,

you'll love it. Oh, was that Churchill's guy? Yeah. Oh, okay. Yeah, at the Yalta Conference. Who I guess he just travels with. I would think so. I thought, I mean, I would imagine all those guys

would travel with their doctors, you know, just for fun. Like what kind of pills you got today? Yeah, and again, I'm watching The Crown. I know I talked about that in the TV, well, not episode, but when we talked about it, and John Lithgow as Winston Churchill is great. What? He's awesome.

When he and FDR like have to part ways after the Yalta Conference, does he punch FDR in the face and say, go. FDR hasn't actually, he hasn't been in it. Oh, okay. Well, look for that scene coming up. Yeah, but it's crazy, Churchill's all over the place. He had the Gary Oldman movie,

and then there were dual Churchill movies. Brian Cox was in another one. Oh, he's, man, it's quality. He's great. Although his Hannibal Lecter was, it was fine until Anthony Hopkins got his hands on that role. Yeah, the rare case where a second actor

totally owns the role. Usually like the first actor will, you know, just probably by the fact that the first. Although I liked, what's the to live and die in L.A.'s guy's name? Who was the lead guy in Manhunter? Oh, William Peterson? Yeah, I liked William Peterson's character.

That's a great movie. More than Edward Norton's version. Oh. In Red Dragon. Because Red Dragon and Manhunter, they're based on the same book. Yeah, yeah, it's the same thing. Yeah.

Yeah, you're totally right. William Peterson way better than Edward Norton in that role. But Jodie Foster better than all of them. Oh, yes. Yeah, all of them put together. Man, I just watched the end of that again the other day. And you're going to appreciate this.

Emily was in the other room in the bathroom or something, I can't remember. And she didn't know what I'd turned it on. And I paused it right at the moment of the penis tuck. Buffalo Bill, when he had his arms out in the Jesus Christ pose. And Emily came in and just got in bed and looked up and was like, oh my God.

What a great movie that was. It had everything. The perfect race frame. Yeah. And everything, had Jodie Foster, Anthony Hopkins, and a penis tuck scene. Yeah. We should probably take a break.

All right, we're off the rails here. You ready? Yes. Break starting now. On the podcast, Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces.

We're going to use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it and now we're calling on all of our friends to come back and relive it. It's a podcast packed with interviews, co-stars, friends, and non-stop references to the best decade ever.

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Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to when questions arise or times get tough, or you're at the end of the road. OK, I see what you're doing. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation?

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Just stop now. If so, tell everybody, everybody about my new podcast and make sure to listen so we'll never, ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts. OK, Chuck. So we were talking about.

Penis tux. Right. FDR famously did that at the Yalta Conference. Oh, my god. So he, no, the reason the reason FDR's death from hypertension really factors into this story is because it was extremely public. OK.

And what FDR basically did without using these last words, he basically said, pointed at modern medicine and said, I beseech you and then keeled over, right? So modern medicine was like, who us? We don't know what we're doing when it comes to cardiovascular disease. And shortly thereafter, the Framingham Heart Study was born. Farmingham.

No, you almost got me. The Framingham Heart Study was born because Harry Truman signed the National Heart Act, which is probably the thing that he's most famous for as president. Yeah, and that included $500,000 in the form of a grant for this study for 20 years, to cover 20 years for this study. And I think initially, a public health service physician, Gilson or Gilkin Meadows said.

It sounds like you messed that up, but you didn't. I think you hit it right on the head. Gilson Meadows. Yeah, Meadows sounds like a weird, you think of him Meadows or something. It sounds like you're drunken saying Meadows. And this was the original quote, which is actually a pretty good mission statement for the study.

Their mission was to study the expression of coronary artery disease in a normal or unselected population and to determine the factors predisposing to the development of the disease through clinical and laboratory exam and long-term follow-up. So there you have it. Not bad. It's got a clinical ring.

It's concise. You can dance to it? Yeah, exactly. So this Framingham heart study was a heart study before it was set in Framingham. And they went to Framingham for a number of reasons. One, they said, well, this is a pretty standard middle America, middle class community, at least of the kind

that we pay attention to in this day and age, right? Meaning it was almost entirely white people, which we'll see as a huge criticism of this study, that the study directors over time have tried to work on. But they said, aside from the almost complete and utter lack of diversity, yes, in this study, it's a pretty good slice of America. It's a small town.

Most of the people there, middle income. It's got a big enough population at the time. This is the 1940s. There was something like 28,000 people that we could get a pretty decent random sample of the population going. But the town itself is small enough. There's only two hospitals.

And in time, there would only be one hospital that we can actually easily keep track of the people in this town. And it's not too far from Boston University, which would win the contrast to carrying out the study on behalf of the National Heart Institute. Well, yeah, and they had also, like you said earlier, proven that they're game for this kind of thing

by participating in that what was called tuberculosis hoedown or something. It had a name. It did have a name. It was called the Framingham Tuberculosis Demonstration. Oh, right. They would be like, watch this.

It wasn't a hoedown. No, but it could be on a Saturday night. It was the hoedown. So yeah, the whole town, well, not the whole town, but the town had gotten behind being test subjects or study participants for a whole other study about 30 years before the heart study began. So they were already kind of like their health care

providers were already aware that this stuff was going on. And at the time, apparently, health care providers, like your general practitioner, that was like the end all be all of your health. That person was meant to know everything about you and everything about disease and how to treat you. And that was that. There weren't any longitudinal studies.

There wasn't any preventative medicine. There wasn't any National Heart Institute. There was nothing like that. It all came down to your general practitioner. So it was really important that the general practitioners and the health care providers in the town of Framingham were on board with this kind of thing because they could very easily have seen this

as encroaching on their turf. But they didn't. And I think the Framingham Study Directors and the people who carried this actual study out deferred to the general practitioners in the town as far as giving advice from the findings and keeping up with the outside medical findings or even the stuff they were finding from the study.

They didn't directly give it to the study participants. They gave it to their doctors. And then the doctors would tell the study participants. So they were kept in the loop. So there was a symbiotic relationship that was forged. Yeah, I thought that was interesting that they just kept the research, like they weren't there to offer medical advice.

They were literally just collecting research. But I do wonder if some of the times they would say, hey, GP of Mr. Donaldson, you really need to get him in like next week. Yeah, like really? Yeah, like he, it's kind of like, I guess, how Churchill's doctor saw Roosevelt. Right.

Like I know we're not supposed to give advice, but my advice to you is to call this guy up and say, maybe you should come in a little earlier than next spring. Right. Or go up your malpractice insurance. So we did say that it wasn't super ethnically diverse, which didn't phase them too much at the time. And it really hit home to me just how like,

just how white probably every major study had been up until this point. Without even like thinking it was a problem, which is being like, I don't know, there's a great study. They're like, well, you know, he didn't include any black people. And they just, it probably just didn't even occur to them at the time. I don't know if it didn't occur to them.

I think that it was mostly that's who their clientele was. I think that that's probably who was being studied, because that's what America catered to at the time, or who America catered to, I should say, at the time. I don't know that that much has changed these days, unfortunately. But I think it was vastly more pronounced back then. Well, I think they're way more inclusive now,

and probably have to be to get research grants these days, I would think. Oh, yeah, yeah, yeah, yeah, yeah, for sure. No, I'm saying America as a whole being catering to. Yeah, I hear you. But that did change in framing him after World War II, apparently, there was an influx of a more diverse population after the war, at least.

Right, and I think by the good Lord, was it the 90s when they added the new cohort? Well, we'll get to the cohorts. OK, well, anyway, sure. Well, spoiler alert, they made the study population more diverse. One thing that is in the credit of the study designers is that they included women at about 50%,

which was totally unheard of in any kind of medical study at the time. Because again, not only did they cater to almost exclusively white people in America at the time, they catered almost exclusively to white men at the time. Yeah, and I think also women, I think heart disease probably still has a stigma of like, yeah, men have heart disease more than women do.

Right, like, what are you, a trucker lady? How do you have heart disease? Go back home. Get out of my doctor's office. Yeah. You dummy. Yeah, which is not the case. Right, no.

But the weird thing is, is what they found from the study, just overall, they found that the stuff that they've come up with, which we'll talk about in a second, is really good at predicting things for white guys, for cardiovascular disease for white guys. But even though women were very clearly represented in the study, they've actually found that those same predictors don't work for women.

So it's kind of led to a separate study of women and how they suffer from cardiovascular disease, because they definitely do. It's just under different circumstances, it appears, than men. Yeah, it's pretty interesting. So let's talk about the beginning of the study, right? Yeah, so they recruited people between the ages of 30 and 59,

initially, because that is the window where you might develop CVD. And they thought, by recruiting people in this range, they would also get a certain amount of people that are already have this appearing, like the symptoms appearing. Right, they didn't, though, actually. It turned out that they had to actually go recruit people who

had cardiovascular disease already and put them into this study themselves. I think because people probably that maybe were on that track don't volunteer for studies like this. Well, they also, it wasn't a very random sample, especially at first, because they initially got participants through word of mouth at civic groups and clubs.

So the presence of a social network or a certain type of social network just does away with randomness right out of the gate. And they ended up recruiting other people outside of these groups and civic clubs and all that, who initially formed a large part of the study cohort to make it a little more random. And I guess they were successful,

because it seems like the idea of it being not very random or not very representative sample of the whole isn't really discussed any longer. So I guess they took care of it by the inclusion of the additional, I think, like 700 people. Yeah, so the idea was that you would come in every two years to give your medical history updated, to get it updated, to have your physical,

to get all your labs done. And they thought at the time, like there's probably, they were smart enough to know that there's probably not one thing that's causing CBD. So collecting all this history from all these people over time, and initially it was gonna be 20 years, but as you will learn, it's still going on today, which is amazing.

They can really get a robust sampling of people and time from kind of all walks of life once they started being more inclusive. Yeah, and they can watch the disease develop or not develop, and since they do like a really, they did a phenomenal baseline exam. And Chuck, actually I saw in the very original inception or conception of the study, was that they were going

to do a baseline exam, and then a second follow-up three to five years later, and that was it. But luckily they had the foresight to be like, no, no, no, let's keep this thing going. Keep it rolling, baby, I'm feeling hot, all right? So by doing this baseline exam and saying, you know, do you smoke, how much red meat do you eat, how much do you drink, how much exercise do you get,

how often do you go parasailing? Like how many kids do you have, what were your parents' medical histories like? By getting this really great baseline exam, they had an idea of all the different factors that could come into play when it comes to cardiovascular disease. And then with these follow-up exams every two years,

they would find people as they got the disease or didn't get the disease, and then they could go back and look and say, well, this person has cardiovascular disease, and they smoke, and they have diabetes, and their parent had a stroke, their dad had a stroke, and they just had a stroke. So they started to see from all of this data, it was basically like, you know how big data

is just enormous right now? That's basically what the Hart Institute did in Boston University, they just went and set up camp in this town, and they started collecting as much data as they possibly could, and then they set about sorting through it and publishing papers based on the findings. Yeah, and you mentioned the cohort earlier,

they were, and I'm just gonna go ahead and say, each of these cohort names is a great band name. Okay. All of them. A blanket, that's a blanket great band name statement. So the initial, you said, when they went out and got another 740 people, and those were the people who had the early signs of CBD?

Yeah, they were included in there. Okay, that's the Framingham cohort. That's everybody, that's the first group. Oh, okay, all of the first group combined was the Framingham cohort. That's kind of a emo-fokie band. Then in 71, they said, you know what, these people are having kids, so what would be awesome

is if we started studying these children and their lifetimes, and they were known as the offspring cohort. So that's like an offspring cover band. Okay, that's terrible. That's not bad. What was offspring? I don't even know.

Oh, remember you got to keep them separated. I do remember that song. They had a couple of good songs. Yeah, and I think the guy, if I'm not mistaken, and I'm not thinking of Milo from The Descendants, this was the guy from offspring, went on to get like a PhD in... Oh, really?

Like biochemistry or nuclear physics or something really impressive. Interesting. Yeah. I was, I'm so, I have no idea about any of that genre, whatever that genre is. I'm not sure what that is either. At the offspring, we're kind of their own thing.

Yeah, but isn't it a part of just the whole like, what was that tour, like the vans, warped tour and all that stuff? Yeah. I know nothing about any of those vans. I'll bet they wore a warped tour now that you mentioned it. They were definitely not a part of what was Lilith Bear.

No, no. But ironically, they did go to a couple of dates just as audience members. Probably so. All right, so the offspring cohort were the kids. That was about 5,100 of them, and then they included their spouses, which was a big deal because like I said,

adding the kids allowed to look for hereditary functions as far as CBD goes. And then the spouses just gave that extra layer of examination when they weren't related. Right. Yeah, so it's almost like a built-in control group as far as looking at hereditary stuff goes, right? For sure.

And then that was also like, I've seen it remarked on, ma'am, my brain's a little broken today, but adding the kids as a second cohort was just a stroke of genius because even before they had any idea that we were going to be able to easily examine genes and DNA, they started building this study data that can be mined now for genetic stuff

thanks to these guys' foresight by adding this offspring cohort. Yeah, that was pretty cool. 1994, the first Omni cohort, first of three, those are all three good band names. Not bad. And this was when they started getting that diversity, they said, hey, maybe we should sort of officially include

this and break this out. So that was made up of about 500 people of Native American descent, African American descent, Hispanic, Indian, Asian, and Pacific Islander. Right. First, and I guess second and third Omni cohorts. And that was 1994. I know.

That's surprising to me that it took that long when they knew out of the gate that it wasn't representative of America as a whole. Yeah, I mean, that's not to say though they didn't have any of those people in the study, but they officially recruited more. Isn't that right? That's my impression, yeah.

Okay. Yeah, I don't know that the original cohort was entirely white, but from what I understand, it was so majority white that it was not representative of America population-wise. And by the way, Omni cohort, that's obviously an EDM band that would probably tour with the crystal method or something like that.

Ooh. And then finally, the third generation cohort, or GIN3, which is their album title. That started in 2002. And I think they were expected to shut that one down next year. That I thought was really weird. Why shut any of them down?

Why not be like, we're gonna follow you to the grave, man. Yeah. We might even dig you up in 10 years after you're dead in case we figure out something new to do with you, you know? Yeah, and these are kids who had at least one parent in the offspring cohort. Is that right? I believe, I think so.

And then there's another one called the offspring spousal cohort. The new offspring spouse cohort. Right, that's just a weird one. Yeah, they're getting a little meta. Yeah, so the new offspring spouse cohort is made up of spouses who, for whatever reasons, weren't part of the original offspring cohort

and have at least two kids in the GIN3 cohort. Is that correct? Yeah, it gets a little wonky. But the point is, is they're adding more and more people in the town as the town's getting bigger and as the town's getting more diverse, they're making the study reflect this population more and more with the hopes that it's going

to reflect America more and more. And again, the study designers and directors have always known that this isn't just like a perfect snapshot of America. There's always been criticisms of it. And I don't know, you want to take a break before we get into this? Yes.

Okay, we will do that right after this. We'll see you in the next video. Hey, dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slipdresses and choker necklaces. We're going to use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade

of the 90s. We lived it, and now we're calling on all of our friends to come back and relive it. It's a podcast packed with interviews, co-stars, friends, and nonstop references to the best decade ever. Do you remember going to Blockbuster? Do you remember Nintendo 64? Do you remember getting Frosted Tips?

Was that a cereal? No, it was hair. Do you remember AOL Instant Messenger and the dial-up sound like poltergeist? So leave a code on your best friend's beeper because you'll want to be there when the nostalgia starts flowing. Each episode will rival the feeling

of taking out the cartridge from your Game Boy, blowing on it and popping it back in as we take you back to the 90s. Listen to Hey Dude, the 90s called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. The hardest thing can be knowing who to turn to when

questions arise or times get tough, or you're at the end of the road. OK, I see what you're doing. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. This, I promise you.

Oh, god. Seriously, I swear. And you won't have to send an SOS because I'll be there for you. Oh, man. And so will my husband, Michael. Hey, that's me. Yeah, we know that, Michael, and a different hot, sexy teen

crush boy band are each week to guide you through life step by step. Oh, not another one. Kids, relationships, life in general, can get messy. You may be thinking, this is the story of my life. Just stop now. If so, tell everybody, everybody about my new podcast and make sure to listen so we'll never, ever have to say bye,

bye, bye. Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts. OK, so I said we were going to get into criticisms. But first, we should probably talk about some of the successes, right? Yeah, and like I said earlier, that so much of what we learned from this today seems just so brainless.

But it's important to remember that before this, I mean, you still, even though you think like, yeah, you smoke cigarettes, you're going to increase your risk of heart disease, it seems like such a second nature thing to know now. But until you have actual scientific proof, you can't say something like that. And this study gave us a lot of these things that we take

for granted now as obvious and proved them. Came out of this study in particular. And cigarettes was a big one. Sure. I read in this article, I can't remember where it came from, Chuck, that I sent to you where they were talking about how one of the reasons why cardiovascular disease spiked in the 40s was because they were giving free

cigarettes out to all of the GIs during World War II. They had like an endless supply of free cigarettes over there, and that they think that directly led to a rise in the, in deaths from cardiovascular disease. Sure did. So, but no one knew for sure. Some people probably suspected every once in a while a newspaper would quote them, they would be called a crack

potter and nut by somebody else in the, in the article. And that would be that, right? So these guys went to town, like establishing a link between smoking and cardiovascular disease. They tried very, very hard to connect diet and cardiovascular disease and had very mixed results. So much so that some of their early work in that realm was just went unpublished for the most part.

They just kind of were like, we don't understand this. So we're not going to include this. But some of the other ones were stroke. Like if you have cardiovascular disease or at a much higher risk for stroke, nobody knew that conclusively before. Yeah, they confirmed that things like cholesterol and blood pressure, abnormalities, increase your risk, irregular heartbeat, atrial fibrillation, increases your risk five

times, menopause. Yeah, that was a, that was a big one. Super big one. Here's, here's one, like seriously, this was figured out in this study that physical activity decreases your risk for cardiovascular disease, while lower physical activity and obesity increases your risk. Like again, this is stuff that we're like, of course, who

doesn't know that? Well, America and the world didn't know that until Framingham Heart Study actually published its results. Yeah, here's one that, if you're in your 40s and you go to get a physical, there's a pretty good chance that at some point after your labs, your doctor will talk to you about your FRS score, your Framingham risk score. It is still widely used today as the standard.

And that is the very sad moment where your doctor says, you have this much of a percentage risk of developing heart disease within 10 years from this date. They tell you you have 103% risk. You say, well, what can it go up to? And they say 100. Yeah, that's not good. So the Framingham risk score is based on a bunch of different

risk factors. And by the way, the term risk factor was coined from the Framingham Heart Study. So that's another thing it gave to the world. Your risk factors are based on your age, your gender, total cholesterol, HDL cholesterol, whether you have diabetes or not, whether you smoke or not, and your systolic blood pressure.

You put all this together, each of those gets a score. You can come up with a really, really good indicator of whether you're going to come down with a cardiovascular disease in 10 years if you're a white guy, to a lesser extent if you're an African-American guy, to a much lesser extent if you're a woman of, I think, any ethnicity. Do you get Episcopal every year? I try to.

It's been, oh, it hasn't been a year yet. I'm just under a year right now, but I need to find a new doctor. Are you, how's your cholesterol? It's great. Man, my family dude. Oh yeah, it runs high? Well, I mean, I certainly don't do myself any favors with

my weight and my diet, but me, my brother, and my sister are all on cholesterol medication. Oh, is that right, statins? Is that what it's called? Yeah, and my brother, like, is in great shape, and so is my sister, so it's, yeah, I mean, it's just a totally Bryant family tradition. Just naturally high cholesterol, huh?

Yeah. Well, I mean, dementia runs in my family, so I'm toast one way or another. Oh yeah, I mean, it's basically you look at your family history and spin the big wheel and say, what's going to kill me? Right, it's like, come on, medical science. Find a cure for mine.

Let's go with that one first. Well, thank God for statins. They're, you know, now my cholesterol is great. So I, since I last went to the doctor, I've begun to introduce butter into my diet way more than I ever had before. Yeah, real butter. Yes, of course.

I like a really, if it has like a picture of an Amish person on the cover of the package, go with that butter. Yeah, the Goodie Daniels butter. Yeah, and I actually, I read a taste test on, maybe, Ranker or something like that of butters. And apparently the ones that are like $20 a pound really don't taste much better than, like, Kerry Gold that you get at the grocery store, just about any grocery store.

So I found, like, oh, that's good. I'm not really missing out on anything. I'll just eat more cheap butter. And just like a little bit of butter on some bread is a really, like, delightful little treat 10 times a day. So I'm actually really interested to see what my cholesterol is like this year. I'm basically just performing a test on myself right now.

Well, and they've learned so much in the past, like, 10 years or so about good fats and bad fats and low fat foods really not being all they're cracked up to be because then they're packed with other things that are bad for you. Yeah, especially high fructose corn syrup. Yeah, it's good. We go with the good local butter called banner butter. It's good.

And, you know, who knows if it tastes any better. But it's locally made, so that's always nice. Is it made from those doomed goats across the street from you? No, we just fed them yesterday, though. Did you? Did you go, I'm so sorry for what's going to happen to you? No, we, I don't think they're doomed. I think they are being raised again and sent to Jamaica,

not for food. For what? Just to play with? For milk and cheese. Just to raise people's spirits? Well, they certainly do that. Look at those goats playing. But, yeah, it's not like every goat has to be eaten to have worth.

No, I agree. I'm just saying. They're also milked in their cheese. We save all our, Emily's a juicing theme now, so we have a lot of green scraps now. So we just save them all, and then about two times a week, we'll take the kid over there and feed the goats. And it's pretty fun.

They bray at us now when we leave our house. Oh, yeah, they're like, hey, bring that over here. I'm doomed. Yeah, they love it. So you guys have green scraps? Let me give you a little piece of advice to pass along to Emily. OK. One word, but I'm going to pronounce it like two.

Vitamix. Oh, dude, we've had a Vitamix for like 10 years. Is that what you use? Yeah. You shouldn't have scraps. You've got to throw all that stuff in there so you get the fiber too. No, we don't throw like the butt end of the celery stalk in there. Oh, OK.

And stuff like that. I got you. Because there's like juicers that just extract the juice and leave all of the fiber. I thought that's what you were talking about. No, no, no. Well, we do two things. We have the Vitamix for a lot of the green smoothies and stuff.

But then we are also juicing some of the stuff. And we'll give the juice scraps to the goats. But we do both. I got you. Like every morning now with some sort of green juice and smoothie. OK. So you do have like a juicer juicer than two, right? Yeah, yeah.

OK. I have another piece of advice for you. You're going to love this one. Get yourself some good mezcal. It's not hard to find these days. Juice some cucumber. Yeah, we've been doing that. Little bit of lime juice, which you don't need to run through the juicer.

And then some sort of sweetener. And thank me later. And then mezcal? Yeah. Oh, yeah. Which is you like. Because Emily's been drinking the vodka with her fresh juices for a cocktail. Yeah, that goes really well with the two.

This is a different, this is something different. You know, the mezcal really stands out with the cucumber makes it pop. Yeah. Give it a shot. All right. Are we going to, let's bring this home. Let's stop torturing all these poor people who are still listening. I think we got off track with butter.

Yeah, I think so too. And goats. So FRS is what we were talking about. Oh, here's another one for you. They've just some little ancillary things they've learned over time because it's not just about CVD. They've learned about things like depression and stress and anxiety, sleep apnea for one, increasing your risk of stroke.

And then they gave a really ingenious thing when they just said, hey, we've got all these people over this big chunk of time. So why don't we start seeing if people give us a little bit of brain matter upon death. And we can start looking into things like Alzheimer's and dementia. Yeah. And they've actually found recently, at least in the framing of population, dementia is going down, which hopefully means that it's going down in the larger population as well. But yeah, they have all this study data and they say, well, let's start mining it for

other diseases as well. And it's becoming not just a gold standard for cardiovascular disease, but for like other neurological diseases as well. And eventually, almost certainly it will become the gold standard for genetic investigations into diseases as well. Yeah. And like we've been talking about the lack of diversity over the year, like basically this is really good results for white dudes.

They have since over the years included other calculators for minority groups for women. The ETH risk calculator is for British minority groups. The Reynolds risk score has been developed for women. And I think a couple of others too, where they've tried to take all this data and then tailor it to a specific group. Yeah. They've also found that people who go on vacation didn't have lower incidences of cardiovascular disease.

So remember to vacate at least twice a year. To vacate. Uh-huh. What else? Oh, that thing about dating people who look like you, that was interesting. Yeah. I guess they saw that in the initial cohort, a lot of people, a lot of married couples looked alike and they think that people were preferentially seeking out people about their

height, their weight, maybe their hair color, who knows, but that that's largely gone away in the second and third cohorts. Yeah. I also read an article that said that they found that human evolution is still going on. They're noticing that each generation of women is slightly shorter, slightly plumper, and I'm talking like a tenth of an inch shorter and something like a half of a pound heavier. But that this is traditionally tied to being able to more easily have live births.

Another way to put it is having kids because a lot easier to have kids, right? What is wrong with me? So they think that this is like as they're seeing in framing them, evolution's still in place, which very much contradicts what a lot of people have long said, which is humans took ourselves out of evolution a while back when we started intervening in medicine and things like that. So just the cool pictures of humanity that this has provided, it's pretty sweet, pretty great study actually.

It is and hopefully this will be, I know they had a little trouble getting extended funding at one point and they had some private institutions that stepped up some kind of unusual ones like Oscar Meyer and I believe one of the cigarette companies, right? And then Nixon eventually, he got out the checkbook and wrote him a big fat check. Probably the thing that he's most known for as president too, continuing the framing of heart study. I read that he got out the checkbook or twisted the arm of the National Heart Institute because one of the early champions of the heart study was Nixon's personal doctor and that's how

it all went down. He's like, turn your head and cough and give us $50 million. You got anything else? Nope. Well, we could probably just talk about framing him for days, but we're going to stop now. I would urge you to go read, I'm not even sure when it was written, but a CBS Sunday morning article from maybe like the early 2000s about framing him in the heart study and it really just kind of gives you a picture of the people there.

And then I also saw when that was critical of it, that was pretty interesting called framing him follies on something called proteinpower.com. Just go read them both. You'll enjoy it. And since I said you'll enjoy it, it's time for Listener Mail. I'm going to call this a follow up on the beach near the Hearst Castle. I think a couple of weeks ago we talked about when I went and I thought I didn't think there were walruses.

I just couldn't remember what they were and they are in fact elephant seals. I said they were sea lions. I was wrong. Oh, that's right. Hey guys, listen to this show on walruses and Chuck referred to the beach near Hearst Castle. They call it Piedras Blancas Elephant Seal Rookery. I think it's funny that you had mentioned that because for our honeymoon last June my

husband and I stayed in Oceano for a week near Pismo Beach and one of our activities for a day was to go to Hearst Castle on Elephant Seal Beach. Of course, Hearst Castle was amazing. I still haven't been in there. I need to check that out. You know that one party scene in Billy Madison was filmed at Hearst Castle. Yeah, I never saw that still. Getting to see the architectural history and artifacts that reside there were great but

the beach unfortunately on that particular day was pretty quiet. I think it was a nap time by the time we got there because most of them were sleeping or adjusting and going back to sleep. Well, it's still fun to see them. Sure. It's not like they're out there with the beach ball like in cartoons. It's fun to be overpowered by their stench when you're downwind of that massive elephant seals.

There were a few males that started an altercation but that ended pretty quickly and wasn't all that noisy. I think the most interesting thing on that day besides seeing them up close was watching them sleep in the water. First, I got a little nervous because I wasn't sure if they were alive but after several minutes of watching one of them, it moved once the waves pushed it close enough to the rocks. However, if you do suggest people to go there, please tell them to be aware there are no

feeding of the squirrel signs. There was a group of preteens that didn't regard the sign and literally got chased by a big fat squirrel. It was hilarious to watch but a little scary. Thanks for the show. Hope you're doing well. Keep up the work and that is Morgan Boddy and Morgan actually just emailed back when I told her she was going to be on and said, OMG, no way, four exclamations, thanks, smiley

face emoji. And then she inserted against her previous surname, Morgan Meyers Boddy. Okay, way to go, Morgan. Thanks for the emojis and the exclamation points too. All for it. If you have a story you want to straighten us out with, you can tweet to us at joshumclark or at S-Y-S-K podcast. You can also go on to facebook.com slash Charles W. Chuck Bryant.

You can also visit facebook.com slash stuff you should know. And it's an email to stuffpodcast.howstuffworks.com and join us at our home on the web, stuffyoushouldknow.com. For more on this and thousands of other topics, visit howstuffworks.com. On the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're going to use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s.

We lived it, and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts.