The Framingham Study and the Constitution of a Restrictive Concept of Risk Factor

One of the first American epidemiological studies of cardiovascular disease, the Framingham Heart Study, is considered to have played a central role in identifying the major risk factors for heart disease and in introducing and diffusing a risk factor approach. Today, a risk factor is usually presented as an individual and biological parameter rather than as a social characteristic, and it is most commonly used as a predictive rather than a causal notion. This paper examines the specific contribution of this prospective study to framing what I call a ‘restrictive’ concept of risk factor. I show that these characteristics owe much to some peculiarities of this study when compared to other contemporary cohort studies carried out in the USA and in the UK: in particular its conception as a large clinical study, its relationship to American constitutional medicine and the division of work between clinicians and statisticians.