Matters of the Heart

A decade of high-gear progress was proudly reported last week by the American Heart Association as it celebrated the tenth anniversary of its reorganization from a narrow-based group of medical specialists to a broad-based outfit with national public participation. In this period, said President Robert W. Wilkins of Boston at the commemorative meetings in San Francisco, surgery on the heart itself has leaped from a hesitant, tentative approach to one of great confidence: there is now nobody with acquired or congenital heart disease who cannot be considered as a prospect for surgery, and many cases can be helped. Equally important has been the successful attack on rheumatic fever, achieved mainly with penicillin. Ranking next, Dr. Wilkins listed ground gains against high blood pressure, now controlled with drugs in most patients, so that surgery is practically disappearing.

For the next decade, Dr. Wilkins predicted, hardening of the arteries and its fatal effects--heart attacks and strokes--will be the prime target, demanding 80% to 90% of researchers' efforts in the field of heart and artery disease.

The shift in emphasis was already evident in the tenth anniversary scientific reports, which devoted increasing attention to the causes of arteriosclerosis and the treatment of its severest effects.

Who Gets It? Diligent researchers offered more facts and fewer theories on the importance of stress and diet as shorteners of life. Main trouble has always been to find two groups of people similar in all but a few respects, then pinpoint the variations as causes of differences in patterns of disease. Doctors from the Medical Col lege of South Carolina and the University of Haiti picked on their local Negro populations as ethnically indistinguishable, then did post-mortem examinations of the hearts and aortas of 139 South Carolinians and 128 Haitians of equivalent ages and the same sex distribution.

From the Charleston area, Dr. Dale Groom reported, the hearts studied showed twice as much atherosclerosis (the form of arteriosclerosis that affects the coronary arteries) as did the hearts collected in Haiti by Dr. Vergniaud Pean. Why? Their diets did not differ significantly except in two respects: the Haitians got far less to eat, and as many as 42% in the poorer classes were underweight, while as many as 30% of better-fixed Charleston Negroes were overweight; also, the Haitians had practically no cholesterol in their diet, while the South Carolinians had six to 20 times as much (mostly from eggs).

At first glance, such data would fix the blame on the diet. But South Carolina's Dr. Groom was not to be stampeded. Pathologist Edward E. McKee (who did all the autopsies, did not know where a particular heart came from until afterward) had checked the aortas with equal care, found surprisingly that just as many Haitian as South Carolinian aortas were diseased. To Dr. Groom, this indicated that something besides diet was to blame, though he did not rule out the possibility that a dietary clue might yet be found.

To him, it seemed most likely that the answer lay in stress, or more precisely, the reaction to stress. Many of the Haitians were even poorer than their South Carolina counterparts, but if they literally did not know where their next meal was coming from, they refused to worry about it. The research team was unanimous that the Haitians slept more, worried less, lived at a slower, less stressful pace (although they were obliged by lack of transportation to take more exercise). Said Dr. Groom: "The life of the American Negro is inherently more competitive."

Who's Shoving? Again, at first glance, this conclusion might seem to have been contradicted by the findings of a Chicago research team, which found no appreciable difference in the patterns of heart-and-artery disease among various strata, from executives to laborers, in a utility company. But they did not go into details of individual personality. It was on this point that a San Francisco study shed light.

Drs. Meyer Friedman and Ray H. Rosenman picked 83 Bay area residents, regardless of their positions in business and industry, who were reported to them by their employers as having 1) intensive drive, 2) profound inclination to compete, 3) persistent desire for recognition and advancement, 4) continuous involvement in multiple and diverse functions subject to time restrictions (i.e., deadlines), 5) habitual compulsion to speed up all their physical and mental functions, and 6) superior mental and physical alertness. For comparison they took an equal number of men of the same ages and physical types, but with the opposite personality type--little drive or desire to compete.

The researchers found that the two groups ate, drank, smoked and exercised about the same. But the driving men had significantly higher levels of cholesterol (a substance involved in atherosclerosis) circulating in their systems, their blood had a shorter clotting time, and they had about seven times as much heart disease.

Reporting on studies at the University of Oklahoma, Dr. Stewart Wolf summed up: "We have found that the man likely to have a heart attack is highly competitive in his attitudes, if not in his behavior; concerned with self-sufficiency and with doing things on his own--and usually the hard way. Looking for new worlds to conquer, he takes less than the usual satisfaction from achievement, and especially he has no time to enjoy satisfaction between chores."

When it comes to treatment after the damage is done, the researchers were more tentative in their reports. Most positive was Houston's famed surgeon, Michael E. DeBakey, who reported that in a random series of 150 stroke victims examined by arterial X rays, no fewer than 43% were adjudged capable of getting substantial relief from prompt surgery.

DeBakey and his team actually performed operations on 69 victims. In some cases they reamed out carotid and other arteries leading to the brain, in others they bypassed a completely shut-down stretch of artery with a Dacron tube to carry blood from a lower stretch of healthy artery to a higher one. Among the 69 cases they found 13 for whom they could do nothing, and had five failures, but in 51 cases they reported success. In some instances this was as great as relief from a substantial degree of paralysis, or loss of speech, or partial blindness, and the improvement has lasted as long as five years.

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