Medicine: Hope in Heart Disease

Unless medicine does something about it, more than half of all Americans now living will die of heart and artery diseases. Doing something about these diseases means spotting prospective victims early and correcting factors that will cause an attack. Last week, at a New York Academy of Sciences conference, top U.S. and international experts came closer than ever before to sense-making agreement on who is likely to suffer an early heart attack and why. And one authority declared that the possibility of preventing heart and artery diseases is at hand.

Factors of Seven. Part of the data for the agreement came from Framingham, Mass. (pop. 44,500). Starting in 1949, a team of epidemiologists has been studying 5,000 Framingham men and women who had no signs of heart disease when they signed up for the project. Withthe statistics completed for eight years, Dr. Abraham Kagan reported:

> Coronary disease has clearly developed in 166 men out of 2,282, but in only 79 women out of 2,846. The men were younger than the women by an average of ten years when they showed the disease, and they had it more severely, with 23 sudden deaths as against two among the women.

> Overall measurements of total blood cholesterol are a good index to the risk of heart disease, especially in men. The danger of a heart attack was almost seven times as great, in the 30-49 age range, for those with an initial cholesterol reading above 260 (in milligrams per 100 milliliters) as for those with a reading below 220. Between 50 and 59, the difference is not so great but still high.

> Blood pressure is an equally potent factor and plays no favorites between the sexes. An initial systolic reading above 180 indicates a sevenfold risk compared with one below 120; there is a smooth gradient in-between.

> Excess weight usually goes with high blood cholesterol, and sometimes with high blood pressure, but appears to have little influence separately.

> Cigarette smokers in general run a double risk of a heart attack and sudden death, as compared with those who smoke pipes or cigars, or who have quit cigarettes, or who never smoked.

>Enlargement of the heart’s left ventricle (its most muscular pumping chamber), as indicated by the electrocardiograph, seems more significant than it did earlier. With enlargement, the likelihood of coronary disease doubles.

> Decreased breathing capacity means more heart and artery disease.

Since blood cholesterol, blood pressure and smoking can all be controlled, Dr. Kagan suggested conservatively that ”the time may now be at hand when the individual physician should attempt prevention of coronary disease in selected patients.”

Exciting Leap. Chicago’s Dr. Jeremiah Stamler went farther. From a study of 1,466 men employed by a utility company there, he drew much the same conclusions about risk as did Dr. Kagan. His hopeful conclusion:

“For the first time in medical history, research has advanced far enough to bring us the possibility of large-scale prevention and control of a major chronic, noninfectious disease. This is a unique and exciting leap forward. It is a far cry from the intellectual atmosphere of only a few years ago, when heart-artery diseases were regarded by many as inevitable consequences of aging.”

Admittedly, it will take time to prove whether control of cholesterol, blood pressure, obesity and smoking will actually prolong life as the statistics indicate they should, said Dr. Stamler. But the time to try, he argued, is now.