Despite all the milestones, a study of this magnitude doesn't go forth without some missteps and criticism. As already noted, the lack of diversity in the study has long been a chink in the armor. This has called into question whether the results are truly generalizable, especially in today's melting pot society.
For example, one review found that the risk algorithm initially established was accurate for black and white Americans; however it estimated too high for Hispanics, Japanese-Americans, and Native American women [source: Davis]. Ideally, the FHS's continuing addition of more diverse groups will mitigate this issue and provide further insight into how genetics and lineage play into CVD. Some scientists have modified the FHS risk score to be more applicable to people of different ethnicities. For example, the ETHRISK calculator is tailored to British minority groups like those of Indian, Bangladeshi, Chinese, Irish and black Caribbean ancestry.
It's also been suggested that the FHS-established risk factors that apply so well to men, may not be indicative of CVD risk in women because as many as 20 percent of women who experience coronary events have none of the associated risk factors [source: Davis]. In a similar move to the ETHRISK calculator, a Reynolds Risk Score has been developed, which includes some other ingredients, like family history and the high-sensitivity C-reactive protein (hs-CRP) test to better determine a woman's risk of heart disease.
Other critics insist that high saturated fat levels — pinpointed by the FHS long ago as related to getting heart disease — are less to blame than the excessive intake of trans fats, high carbohydrates and sugars [source: Healy]. Indeed, the FHS originally found that there was no relationship between a participant's intake of calories from fat and his or her cholesterol level. It also seemed as if a drop in cholesterol levels correlated with an increase of CVD death for those over age 50. These findings puzzled the researchers and were not included in their official report [sources: Eades, Malhotra].
"A lower cholesterol is not in itself the mark of success, it only works in parallel with other important markers, like a shrinking waist size and diminishing blood markers for diabetes," writes cardiologist Aseem Malhotra.