Medicine: Cardiac Puzzle

A new study raises questions

Almost everyone is convinced that giving up cigarettes, reducing high blood pressure and cutting down on cholesterol lower the risk of death from heart disease. Proving it, however, is difficult. Ten years ago, the National Heart, Lung and Blood Institute undertook the largest study ever, involving 12,866 men between ages 35 and 57 who were considered to be high-risk candidates for heart disease. Half were assigned to a special intervention (SI) program in which they received treatment for hypertension, plus counseling to reduce their cigarette use and intake of cholesterol. The other half relied on their usual health-care sources (UC). Last week the results were revealed, and, once again, there were more questions than answers.

No significant difference was found between the two groups in the number of deaths from coronary disease. The most probable explanation is that physicians caring for UC subjects, knowing that their patients were participating in the study, may have given them the same advice provided to SI patients. Another finding seems to call for further research: among subjects with hypertension and EKG abnormalities, there were 57% more deaths in the SI group than in the UC. Since the SI patients received drug therapy for hypertension, the study raises the disturbing possibility that the extra drug treatment contributed to the deaths.