HEART ATTACK: CURBING THE KILLER

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP78-05077A000100090020-2
• Release Decision: RIPPUB
• Original Classification: K
• Document Page Count: 6
• Document Creation Date: December 9, 2016
• Document Release Date: May 26, 1999
• Sequence Number: 20
• Publication Date: May 1, 1972
• Content Type: MAGAZINE

Bernard Gotfryd-Newsweek, Courtesy St. Vincent's Hospital
Coronary-care unit: With constant monitoring and fast action, 60,000 lives are saved each year
Heart Attack: Curbing the Killer
0 ran Bentley, 43, a technician for a shocked the heart back to normal
Ilouston instrumentation firm, had rhythm. When Bentley came to, he was
rust settled down in his living room for a lying in the hospital's coronary-care unit,
ulidnionung cup of coffee. Then, with his body enmeshed in wires and tubes
devastating suddenness, it struck. Bent- that enabled doctors and nurses to main-
ley felt a gnawing pain deep within his tain constant vigil over his heartbeat and
chest and an oppressive sensation of vise- take immediate action should another
lil,e pressure, or squeeze, beneath his arrhythmia occur. Fortunately, all went
hreast hone. It was.the beginning of a well. Last week, Bentley was convalesc-
heart attack. ing at home and expecting to go back to
't`he attack came one Saturday last work by June.
Varch. As was his custom, Bentley had Heart attacks strike more than 1 mil-
i iscn early, eaten a breakfast of bacon lion Americans each year, and Oran
and eggs and gone out to work on the Bentley's case dramatizes a frightening
sand of his three-bedroom brick home. new trend. For at 43, Bentley is one
11e was used to heavy work, and he more of a steadily growing number of
didn't even work up a sweat trimming relatively young men to be stricken by
the branches off several trees and chop- coronaries. One has only to scan recent
'
ping down another. That
s why the pain headlines and obituaries to find other ex-
N~ as so puzzling. amples, many of them more tragic than
'1'lie first thing Bentley did was lie Bentley's. New York Mots manager Gil
down on the floor. "It felt as if I could Hodges was only 47 when he was fatally
iust lie clown and stretch, it would go stricken after a round of golf earlier this
away," lie recalls. When that didn't work, month. Former President Lyndon B. John-
Ile went outside and walked around; by son, recovering last week from his second
this time, he was having trouble getting coronary, was 46 when he suffered his
his breath. The pain was also becoming first, nearly fatal, heart attack in 1955.
more intense and spreading to his shoul- Last fall, Detroit Lions wide receiver
tiers, just as his legs gave way and ,be Chuck Hughes, who was only 28, col-
slilniped slowly on the patio, Bentley's lapsed and died during a game. Dave
daughter saw him and called a doctor. In Stallworth, now playing for the Baltimore
live minutes, a fire department ambu- Bullets, was lucky enough to survive the
lance was rushing him to St. Luke's coronary he suffered five years ago at 25
.
a
c
s eac
year never reach
Episcopal Hospital.. According to the American Heart As- a hospital, with its life-saving technology.
lieutley doesn't remember what hap- sociation, the trend for heart attacks For many, like Gil Hodges and Chuck
penecl next, but three minutes after he among younger men has been rising Hughes, death comes in a matter of see-
:rrrive?1 in the emergency room his heart steadily for two decades. For men be- onds or minutes. These deaths explain
lihrillated; the ventricles shivered and tween 25 and 44, the coronary death in good measure why the death rate
stopped pumping blood. Fortunately, rate has gone up 14 per cent-from 46 from heart attacks has failed to take a
this potentially lethal episode was spot- to 52 per 100,000 since 1950. The mor- downward turn-despite the best efforts
led at once by a technician watching tality among men between 45 and 64 has of researchers and clinicians. Asa cause
Bentley's electrocardiograph monitor and risen 4 per cent-from 575 to 598 per of death, heart attacks continue to take
electrodes quickly placed on his chest 100,000, True heart attack re o o ? + 11
A r% It Newsweek, May 1, proved For Release 20b0108129 0- 73
nantly strike the elderly. But 176,000 of
the 675,000 Americans who will die from
coronaries this year will be under the
age of 65, victims of what public health
officials call "premature" heart disease.
But Bentley's case is also dramatic evi-
dence of a more hopeful trend in the
fight against heart disease. Had his heart
attack occurred just six years ago, lie al-
most certainly would have died from his
episode of fibrillation. Then few hospi-
tals, including St. Luke's in Houston,
equipped their emergency rooms with
portable monitors and defibrillators. And
fewer still had coronary-care units for the
detection and treatment of the early
complications of heart attacks. Today,
the majority of the nation's 7,000 hospi-
tals have such units, and they are credit-
ed with saving up to 60,000 lives each
year. This week at the Inter-American
Congress on Cardiology, a Harvard sur-
geon will describe some daring new sur-
gical methods for further reducing deaths
among patients hospitalized after heart
attacks.
Death Comes in Seconds
But the tragic fact remains that all the
innovations have had relatively little im-
pact on the growing death toll from cor-
onaries. More than half of those who die
of heart
tta
k
h
 cancer, strokes and accidents combined.
the strokes that take more than 200,000
Onc considered in car. In the arteries
qtlenep~aa~~~f? Ad?Gt000Y002
scA o the heart, they account for heart it-
emerged as a national e
id
i
l
p
em
c ear
y
in the century. The epidemic increased
in ferocity as control of such major dis-
ease killers as diphtheria and pneu-
monia extended the life span of the
average American and lofted him into
the coronary-prone age ranges. But to
many public-health experts, that is only
part of the story. The transition from a
predominantly rural to an affluent urban
culture has also changed the average
American's life-style. Its hallmarks: a
rich diet, sedentary living, cigarette
smoking and a high input of tension.
"Just as TB was the prevalent disease in
a young industrial society," says Dr. Jere-
miah Stamler, director of the Chicago
Coronary Prevention Evaluation Pro-
gram, "the disease of a mature industrial
society is coronary disease."
Clearly, the coronary epidemic will not
be curbed, as the infectious diseases
were, by the simple development of
drugs or vaccines. If experts like Stamler
are right, nothing less than a restructur-
ing of the American way of life may be
required to bring heart disease under
control. And there is still serious ques-
tion whether it massive change in diet or
other patterns of life-style will appreci-
ably reduce coronary deaths. But the
evidence is accumulating that for the
first time there is real hope that a major
assault can be mounted on many levels
against the nation's No. 1 killer.
Seek Out the Mysteries
Within the next few weeks, Congress
is expected to authorize the National
Heart and Lung Institute to spend $1.4
billion over the next three years on the
initial phases of the attack. Doctors can
now predict with reasonable certainty
just which Americans have the greatest
risk of suffering heart attacks, and part of
this expenditure will go to establish pre-
vention clinics throughout the U.S. The
bill will also provide for 30 brand-new
centers for basic and clinical research.
Already, NHLI has launched a series
of studies to determine once and for all
whether a change in living patternspatterns-in-
M100-61i
f 066za
Diabetes
Robert Rltte,
Annual mortality rates in U.S.
eluding the diet-would benefit the aver-
age American. Other studies are de-
signed to improve treatment of coronary
victims. Further basic research is under
way to seek out the mysteries of the in-
sidious process that underlies most disor-
ders of the heart and blood vessels-
atherosclerosis. "What is hanging over
all of. our heads," says Dr. Stephen
Scheidt, a cardiologist at New York Hos-
pital-Cornell Medical Center, "is the
genesis of atherosclerosis. And, in my
opinion, it is a pediatric problem."
Simply put, atherosclerosis is the grad-
ual accumulation of pearly-gray deposits
of fatty substances and fibrous tissue in
the lining of the body's arteries, and most
researchers agree that it begins early in
life. Yellowish fatty streaks can be found
in the aortas of children by the age of 3,
and in the coronary arteries of 10-year-
olds. Although harmless in themselves,
they are believed to form the foundation
for atherosclerotic deposits. Such depos-
its can interfere with the blood flow in
many arteries in the body, including the
brain, where they account for most of
(Diastolic)
Three Major Coronary Risk Factors
Rates of first heart attack per 1,000 of male population
Under 175 200 225 250 275 300
175 to to to to to and
200 225 250 275 300 Over
..- ? --uttii iciu CXalumaue,n or young
men killed in the Korean War-a classic
study in the atherosclerotic process-
showed that nearly 8 out of 10 had ap-
preciable atherosclerosis of the coronary
arteries; in 10 per cent, the process had
already closed off most of one or more
major arteries. By the age of 50, the cor-
onary arteries of most Americans show
significant signs of atherosclerosis.
Miles of Blood Vessels
The heart is basically a hollow muscle
,
and no muscle in the body is more de-
pendent on an adequate supply of oxy-
gen-bearing blood. Roughly 100,000
times a day, the heart contracts with suf-
ficient force to pump blood through
60,000 miles of blood vessels. The heart
muscle receives the blood to accomplish
this job through the two coronary arter-
ies, so-called because they lie like a
crown over the top of the heart, Most
vulnerable to atherosclerosis is the left
coronary artery that feeds the left ven-
tricle, the heart's main pumping chamber.
Coronary heart disease occurs when
the supply of blood to the heart muscle
no longer meets its demand for oxygen.
It may take the form 'of angina pectoris,
periodic pain in the chest usually devel-
oping at times of physical exertion or
emotional stress. Narrowed by athero-
sclerosis, the coronary arteries are not
quite capable of delivering sufficient
blood to the heart muscle at such times.
Patients may live for a number of years
with periodic bouts of angina, relieving
the symptoms with rest or with drugs
such as nitroglycerin.
The typical heart attack may occur
without warning and is usually thought
to be caused by the formation of a blood
clot over an atherosclerotic deposit, com-
pletely blocking one of the coronary ar-
teries or its branches. Recently, a num-
ber of pathologists have come to believe
that many coronary occlusions may be
directly caused by total blockage by ath-
erosclerosis, which would call into ques-
tion the value of anti-coagulants as a
means of preventing or treating heart at-
SMOKING
HABITS
75 85 95 105 Never Past Pipe or r/2 Pack I Pack Over
to to to and Smoked Only Cigar or Less Per Day I Pack
85 95 105 Over Only Per Day Per Day
Approved For Release 2000/08/29 : CIA-RDP78-05077A000100G90020"-2
BLOOD
150 - PRESSURE
Newsweek, May 1, 1972
 MEDkINE `
tacks. >yA-pprawedhFQrsrR 6e- 2QQQr/Q8 29 P P1~t, i>RP , 7A0(~ t1 (r090020r 2 victims, even if
unary occlusion is myocardial infarction, a coronary victim to be. In the early saved from the sudden death of ar-
the death of part of the heart muscle, 1960s, before coronary-care units became rythmia, may yet succumb from cardio-
What determines whether the victim of a commonplace, a third of patients ad- genic shock, a complication that accounts
myocardial infarction survives is how mitted to hospitals died. But the CCU's for nearly 15 per cent of deaths among
much of the muscle is destroyed and how have reduced the death rate by at least hospitalized heart-attack patients. This
well collateral branches of the coronary half, largely by preventing and treating kind of shock results from failure of the
arteries can take over blood supply once potentially fatal arrhythmias such as yen- heart to maintain sufficient pumping ac-
provided by the occluded vessel. tricular fibrillation and ventricular tachy- tion due to extensive damage to the car-
But death can also strike swiftly be- cardia-the potentially lethal rapid con- diac muscle. The victim's blood pressure
cause of disruption of the nerve system traction of the ventricle, drops precipitously, depriving major body
that controls the heartbeat, leading to Nearly every patient admitted with a organs, including the kidneys and brain,
arrhythmias such as fibrillation or cardiac suspected heart attack at New York Ilos- of blood. Although drugs such as adi?en-
arrest. Victims of this kind of sudden pital, for example, is taken to the fifteen- alias sometimes relieve early signs of
death may include persons with long- bed CCU where he is quickly hooked up pump failure, nine out of ten stricken
standing angina or in the early stages of to monitoring devices. At a central sta- with cardiogenic shock die. Thus, shock
an infarction. In many cases, however, tion, specially trained nurses monitor the remains the major unresolved problem
the patient has no warning of an impend- electrocardiograms of each patient; if a in the treatment of ]kart attack victims
ing attack; even a minimal amount of major irregularity in the heartbeat oc- in the hospital.
atherosclerosis can trigger a fatal arrhyth- curs, an alarm signal summons help to the Recently, however, two dramatic sur-
gical techniques to prevent cardiogenic
shock have come under intensive investi-
gation. The first, developed by Adrian
Kantrowitz of Detroit's Sinai Hospital, in-
volves insertion of a device to assist the
pumping action of the faltering heart. A
plastic balloon is inserted through an ar-
tery in the patient's leg and brought to
rest in the aorta, the body's main artery.
Electronically coordinated with the ac-
tion of the heart, the balloon inflates be-
tween each heartbeat and gives an
extra boost to send blood through the
patient's body.
Vein Grafts for Bypasses
Cooper (left) and patient: Can exercise prevent coronaries?
mfa if situated in a critical area of the
heart. Such deaths account for most of
those occurring outside the hospital.
But thousands of Americans die or risk
death because they are unable to recog-
nize the early symptoms of a heart attack
and seek help in time (page 79). Many
others are psychologically unwilling to
face up to the possibility that they may
have suffered a coronary. In a survey of
160 coronary patients who eventually did
arrive at a hospital, Doctors Arthur Moss
and Sidney Goldstein of the University
of Rochester found that there was an
average delay of three and a half hours
between the time the first symptoms ap-
peared and hospitalization. In some cases,
patients procrastinated for several days.
Some patients confused their symptoms
with stomach upsets, Moss and Goldstein
reported, while others gave excuses for
patient's bedside, Recently, round-the-
clock monitoring has made it possible for
CCU staff physicians and nurses to pre-
vent major rhythm disturbances. The
monitors disclose premature contractions
of the ventricles, subtle irregularities in
the heart rhythm that are now known
to trigger fibrillation and tachycardia.
These irregularities can often be correct-
ed by intravenous doses of lidocaine, a
local anesthetic similar to Novocain and
used as a heart drug since the mid '60s.
"Liclocaine," says Scheidt, "is a true won-
der drug."
Since every minute after a heart at-
tack counts, hospitals now use mobile
CCU's to bring the life-saving benefits of
cardiac monitoring and resuscitation to
the patient stricken at home. Just such a
unit, directed by Dr. Richard Crampton
of the University of Virginia Medical
Center and equipped with a portable
e are now on
The fact i. however, that now more and Mrs. Charles Robb, in Charlottesville. the verge of developing therapies," notes
76
NPwewnnlr Mu- 7 70^7q
men
logical dAp ftdeFbv1 syk a 2Q001=29ul C1ee x e _ rf-3cA e77~Iihod ell dar~yr in which the
In the other technique, some surgeons
now operate on the heart itself to im-
prove the blood supply to the heart
muscle. Using an operation devised at
the Cleveland Clinic for the relief of se-
vere angina, they remove a section of a
vein from the patient's leg. Pieces of the
vein are. then grafted from a point in the
coronary artery above the site of the oc-
elusion to a point below, providing a de-
tour for blood to flow into the damaged
heart muscle. The technique is still high-
ly experimental and many physicians feel
such surgery is too risky for coronary vic-
thus. But at the Inter-American Con-
gress in San Francisco this week, Dr.
Charles A. Sanders of the Massachusetts
General Hospital will report that the
balloon-assist device and vein-bypass
grafts are saving a third of patients at his
institution who otherwise would have
died of cardiogenic shock.
At nine centers around the U.S., mean-
time, NIILI is sponsoring detailed re-
search into the nature of heart muscle
damage after heart attacks. In one set of
studies, a balloon is inserted into the ar-
tery carrying blood from the lung to the
heart to make delicate measurements of
pressure in the left ventricle.
Sophisticated research on animals is
also yielding new clues on ways to limit
the damage caused by a coronary. In the
earl
t
f
h
y s
ages o
a
eart attack, the studies
ness to bother their doctors at night. monitor and defibrillator, was dispatched have shown, there is an area of the heart
Many patients, Moss and Goldstein to former President Johnson's side when muscle that is permanently damaged sr-
concluded defer treat
t t f I I
delaying treatment such as an unwilling-
 D/CINE
.. s ,.:2:4001,=2 :. RDP7.9.-0 7AO0Q10009002 -~1
ts;>aw- W Toe SYMPTOM
1 /;cs are the usticlf warnings of i?Feat t attack:
How to Tell When You're Having a Heart Attack-And What to Do About It
* Prolonged, heavy pressure or squeezing pain in the center of
the chest, behind the breastbone.
* Pain may spread to the shoulder, arm, neck or jaw.
* Pain or discomfort is often accompanied by sweating. Nausea,
vomiting and shortness of breath may also occur.
Dr. Peter Fromrner of NHLI, "which
will reduce the size of the infarct-the
amount of muscle that is going to die."
13ut new ways of treating the heart-
attack victim, however effective, will
not be enough to curb the coronary epi-
demic. Mass diseases, so the public-
health axiom goes, require mass solu-
tions. The control of 'I'll owed more to
improved sanitation in the cities than it
did to any drug. Similarly, a growing
-imnber of experts agree, prevention
rather than clue is the only hope for the
control of heart disease. "We're now at
the point," says Chicago's Doctor Stain-
lc'r, "of delivering to doctors the ability
to predict heart disease with a multiple
set of measurements,"
Born to High Risk
The measurements are based on a
constellation of factors that have been
linked in one degree or another with
lie occurrence of heart attacks. Two of
the risk factors are beyond control, at
least for the foreseeable future: these
are heredity and membership in the
finale sex. Heart attacks, particularly
those that strike at an early age, seem to
run in families, although the precise
genetic defects involved are unknown.
't'here are a few relatively rare genetic
diseases that result in extremely high
levels of fatty substances in the blood
and those who are affected by them have
an inordinately high heart-attack risk.
As for sex, hormonal differences are be-
lieved to account for the fact that heart
attacks are five times more common
among men than among women before
the menopause. After the change of life,
when estrogen production diminishes,
the coronary disease rate for women be-
gins to creep up.
Many other coronary risk factors, rang-
ing from obesity and stress to physical
inactivity and a tendency toward gout,
can be brought under control. And hard
evidence is gradually being assembled
to show that such measures reduce the
heart-attack risk. Of the entire constella-
tion of risk factors, however, three stand
out above all others and offer the most
innnediate hope for doing something
about the coronaries; they are high
levels of cholesterol in the blood high
ACT IMM E5V
+' Sometimes these symptoms subside and then return. Don't
wait. Minutes count. Act immediately.
* Call your doctor and describe your symptom,
* If your doctor is not immediately available, ,tit to a hospital
emergency room at once.
* The decision to act should not l .,left to the patient alone.
It is also the responsibility of the husband, relative or
friend.
tors has been shown dramatically in the
combined results of a number of studies
in which thousands of presumably
healthy men and women have been care-
fully observed over a decade or more
(page 74). Thus, men with cholesterol
rates of more than 260 (milligrams per
cubic centimeter of blood) are twice as
likely to suffer heart attacks as those
whose cholesterols are 200 or below.
Among men whose diastolic blood pres-
sure (the pressure between heart con-
tractions) is 105 or above, heart attacks
are three times as common as they are
among men with readings of 85 or below.
\len who smoke more than a pack of
cigarettes a day run three times as great
a risk of a coronary as those who have
never smoked and are especially prone
to sudden-death attacks. Finally, a man
who combines all three of these factors
multiplies his coronary risk eightfold.
Just how smoking plays a role in the
development of heart attacks has not yet
been established. It is known, however,
that nicotine increases the heart rate and
intensity of contraction and raises the
oxygen requirement of the heart muscle.
Smoking has also been found to increase
the clotting tendency of the blood. The
best guess at the moment is that smoking
doesn't have anything to do with the
development of atherosclerosis per se,
but may trigger a heart attack in an
individual whose arteries are already
clogged, A man who gives up cigarettes
reduces his risk of a heart attack to
nearly the level of a non-smoker.
Half Don't Even Know
The link between high blood pressure
and heart attacks is also largely unex-
plained. One theory is that increased
pressure within the arteries tends to
force cholesterol in the blood into the
artery lining. Fortunately, several highly
effective drugs, including reserpine and
hydrochlorothiazide, are available for the
control of hypertension and a recent
study of 380 hypertensive men carried
out by Dr. Edward W. Freis of the Wash-
ington VA Hospital suggests that these
drugs can reduce the chance of heart at-
tacks. The major problem with the large-
scale prevention of heart disease by the
control of high blood pressure is one of
adequate diagnosis. More than half of the
20 million Americans who are hyperten-
sive don't know it. And 7 out of 10 who do
are not receiving adequate treatment.
Moreover, many experts believe, even
so-called "high normals" (90-95 diastol-
ic) run an added risk of coronaries.
Of the trinity of major risk factors,
blood pressure and k' ~
blood /S ~1~1Y RalaaCa 9nnningi9a r1ln_R 7R n
Newsweek, May 1, 1972
 as Because We cry price
ingful features.
I.: I Features like truly automatic
time. Plus one no other camera can
sharp reason why Konica can claim
"the' lens alone is worth the price."
Immodest? Ask the man who owns
a Konica. You'll choose one, too.
Hire a veteran. Hire experience.
A veteran _q
a veteran cook,
a veteran
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a vr a i
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a veteran programmer
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L
Don't forget. Hire the vet.
For help In hiring veterans, contact your local office of the the State Employment Service; for on-the-job training in-
formation see your loco V era A inistrat' f
Arrnr?v r elease
R~ I.
7r7 OG11OfrO9G02N-2i cholesterol
levels. Cholesterol is produced by the
liver and plays an essential part in the
structure of body cells and the synthesis
of various hormones, including the sex
hormones. But cholesterol, along with
lesser amounts of a group of fatty sub-
stances called triglycerides, is a prime
constituent of atherosclerotic deposits in
the arteries. And researchers have long
suspected that cholesterol floating in the
blood is the source.
A diet high in cholesterol-containing
foods, such as egg yolk and saturated
fats, which are largely derived from
meats and dairy product, tends to raise
blood cholesterol levels. A member of
surveys of populations in many parts of
the world show almost without exception
that cholesterol levels and heart-attack
.100 Lowenlhnr-Maglc Lantern
Stamler: Predicting heart disease
rates are lowest in countries where the
diet is low in fats and cholesterol, and
highest in nations where the diet is high
in these substances. The latest such
study, in which men ages 40 to 59 in
seven countries were followed for about
a decade, showed that Americans had
four times as many heart attacks as Japa-
nese. In the American diet, according to
the study, 17 per cent of the calories
were derived from saturated animal fats
as compared with only 3 per cent in the
Japanese diet.
Cholesterol levels can be lowered by
reducing the total amount of fat in the
diet and by substituting polyunsaturated
fats, largely derived from vegetable
sources such as safflower oil, for saturated
fats. But as yet there has never been a
definitive study proving that such dietary
manipulations reduce heart-attack risk,
Several small studies, however, suggest
that this may he the case.
One of these studies involved 846 men
5077AOOGI VA
Newsweek, May 1, 1972
 ed For Relse se 2000/08/29 : CIA-RDP78-059ri!A000100090020-2
Robert R. McElroy-Nowswook
Joggers: Help or hazard?
Hospital in Los Angeles. Half the men
ate only ]can meats and specially proc-
essed foods such as hot dogs, cheese
and ice cream that contained polyun-
saturated rather than saturated fats. The
remainder stuck to a diet with the nor-
mal American saturated-fat content.
Those on the polyunsaturatc regimen, it
was found, had nearly a third fewer
coronaries than []lose on the, standard
diet. The men on the polyunsaturate
diet, however, did show a disconcerting
increase in the risk of developing cancer.
But whether their diet was responsible
remains highly questionable.
You Must Change Your Life
cruited more than 500 "high risk" volun-
teers in the 40-to-59 age range who
agreed to modify their diets, smoking and
exercise habits and lose weight. At the
end of seven years, the volunteers have
shown a death rate from coronary heart
disease and sudden death 75 per cent
lower than statistically expected rates.
The much-touted benefits of jogging
and other forms of exercise now are
questioned by a good many heart re-
searchers, especially if undertaken by
previously sedentary middle-aged men.
If unsupervised, exercise can trigger
sudden death in a deconditioned man,
and no one in middle age should take
up jogging without an EKG. However, a
carefully planned training program tends
to slow the heart rate and increase the
efficiency of the heart muscle-or so
many researchers contend. At the least,
exercise may help control excess weight,
in itself a coronary risk factor. At the
Institute for Aerobics Research, Dr. Ken-
neth Cooper has put some 1,000 men,
some of them victims of previous coro-
naries, through a regimen that includes
jogging, tennis and handball. Its purpose
is to bring each man up to the highest
level of physical conditioning of which
he is capable and encourage him to
maintain it after he has left the institute.
By 1975, Cooper will be ready to pub-
lish a five-year follow-up study that he
hopes will prove whether steady exer-
cise prevents coronaries.
The Mystery Factor
The role of emotional stress and the
pressure-cooker urban environment as a
contributing factor to heart attacks has
been much publicized but remains
largely undocumented. Most cardiol-
ogists agree that a sudden emotional
shock can trigger a heart attack
in an already predisposed individual, but
whether long-term exposure to stress af-
fects the heart or the atherosclerotic
process hasn't been proved.
In one of the more intriguing investi-
Perhaps the most definitive test of gations into the psychological aspects
whether lowering blood cholesterol will of heart disease, Drs. Meyer Friedman
protect against heart disease is about to and Ray H. Rosenman of San Francisco's
get under way at twelve centers under Mount Zion Hospital have delineated
NIILI sponsorship. Some 3,600 persons a coronary-prone personality pattern.
suffering from genetic disorders leading Through careful interviews, the so-called
to extremely high cholesterol and triglyc- type A man reveals himself as hard-driv-
eride levels will follow a strict diet and ing, excessively ambitious and driven by
take a cholesterol-lowering drug, choles- deadline pressure. A type A man, Fried-
tyramine. In another NHLI study to be man claims, will give himself away every
completed next year, 8,341 men who time by a tendency to finish his inter-
have had heart attacks have been taking viewer's questions for him. The more
various cholesterol drugs to see which, placid type B man, on the other hand,
if any, offers protection against subse- would regard such an interruption as
quent heart problems. By June, NHLI impolite.
plans to launch a program to determine Among 3,500 men observed for four
how some 11,000 Americans might over- years, Friedman found that type A men
come a multiple risk due to combinations had two and a half times as many cor-
of high cholesterol, heavy smoking and ovaries as their type B counterparts,
hypertension. Friedman, who classifies himself as type
In a similar, but smaller, study Chi- A and has had a coronary to prove it,
cago's Stamler has already produced notes that such men run higher than nor-
promisin i r ~N~ '?te 2C b f~91s: A~RDR'7~ 05077
heart atA s O a e rdd icei Ally corn- normallyfig 1 level is a response to stress
preventive changes in life-style. He re- and may not really have anything to do
with the genesis of heart disease. "This
type of man," Friedman says, "starts
full speed on all organs. Ile starts show-
ing biochemical disorders long before he
has a coronary."
History is replete with examples of
major diseases that have been brought
under control before their causes were
fully understood. William Jenner did not
know smallpox was caused by it virus.
Even today, the most astute endocrinol-
ogist can't explain how insulin controls
diabetes. Perhaps the same will apply to
the conquest of heart disease.
In any case, with the major risk factors
so well identified, many experts think
that now is the time to try to save lives
by intensive screening programs to find
the estimated 20 per cent of the popula-
tion that is vulnerable to heart attacks
and begin preventive therapy. Any doc-
tor can tell if his patient has an elevated
cholesterol or high blood pressure,
smokes or is overweight. But the success
of treatment will depend largely on the
patient and his willingness to change his
life. "The potential heart-attack victim,"
notes Dr. William Kannel of NIILI, a pio-
neer in the identification of risk factors,
"is going to have to play an active role in
his own salvation. He can't depend on his
doctors to bail him out."
But to have the greatest impact, pre-
ventive measures should begin before
the signs and symptoms of atherosclerosis
appear. Even without final proof of ef-
fectiveness, the heart experts insist that
all Americans should make prudent
changes in their diets. Children would
stand to benefit the most, since there
is evidence that early changes in the
arteries can actually be reversed by re-
clueing cholesterol levels. Indeed, to-
day's children, placed on a low-fat regi-
men and taught to avoid smoking, could
become the first generation of Americans
to see the coronary epidemic subside.
00100
Bentley: Shocked to life