CORRESPONDENCE: LETTER TO THE EDITOR
Fantastic Voyage Through Cardiology: From 1969 to 2008
George A. Mensah, MD*
* National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-40, 4770 Buford Highway, NE, Atlanta, Georgia 30341-3717 (Email: GMensah{at}cdc.gov).
Hecht and Colmer (1) deserve praise for their fantastic account of 2 generations of cardiology encompassed in 1 still-living patient. As I reviewed their wonderful presentation of historical text, images, and videos, I could not help but reminisce about the joy of discovering, as a medical student, the numerous interventions possible in cardiology practice. During my cardiology fellowship training, publication of Waller's (2) account of "crackers, breakers, stretchers, drillers, scrapers, shavers, burners, welders and melters" in the future treatment of coronary artery disease only added to the excitement about the specialty.
In my old age, however, I have become equally impressed with the power of public health measures and the impact of prevention (3,4). Aspirin, beta-blockers, statins, and the control of blood pressure and cholesterol play a crucial role in reducing cardiovascular morbidity and mortality (4). Similarly, policy-based initiatives (4,5) and other public health measures that reduce population exposure to risk factors or support health-improving behaviors, such as smoking cessation, increased physical activity, and a diet rich in fruits and vegetables, play important roles, although they are by no means as glamorous as the interventions described by Hecht and Colmer (1) or chronicled by Waller (2).
Several studies from the U.S., New Zealand, Scotland, England, Wales, Ireland, and Finland suggest that 45% to 75% of the decline in coronary mortality can be attributed to risk factor changes, and the remaining 25% to 55% to treatments (6). In fact, improved risk factor levels explained 53% to 72% (and treatments only 23%) of the decline in coronary mortality in Finland (7). It would be highly instructive to learn from Hecht and Colmer how the spectrum of risk factors and major preventive practices changed during this fantastic voyage. In the words of the legendary broadcaster, Paul Harvey, providing this account may tell "the rest of the story" (8).
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Please note: The findings and conclusions in this letter are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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1. Hecht HS, Colmer M. Fantastic voyage: a patient's journey through cardiology from 1969 to 2008 J Am Coll Cardiol 2008;52:1366-1369.[Free Full Text]2. Waller BF. Crackers, breakers, stretchers, drillers, scrapers, shavers, burners, welders and melters—the future treatment of atherosclerotic coronary artery disease?. A clinical-morphologic assessment. J Am Coll Cardiol 1989;13:969-987.[Abstract] 3. Pearson TA, Bazzarre TL, Daniels SR, et al. American Heart Association guide for improving cardiovascular health at the community level: a statement for public health practitioners, healthcare providers, and health policy makers from the American Heart Association Expert Panel on Population and Prevention Science Circulation 2003;107:645-651.[Free Full Text] 4. Smith Jr. SC, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update J Am Coll Cardiol 2006;47:2130-2139.[Free Full Text] 5. Frieden TR, Bassett MT, Thorpe LE, Farley TA. Public health in New York City, 2002–2007: confronting epidemics of the modern era Int J Epidemiol 2008;37:966-977.[Abstract/Free Full Text] 6. Capewell S, O'Flaherty M. What explains declining coronary mortality?. Lessons and warnings. Heart 2008;94:1105-1108.[Free Full Text] 7. Laatikainen T, Critchley J, Vartiainen E, Salomaa V, Ketonen M, Capewell S. Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997 Am J Epidemiol 2005;162:764-773.[Abstract/Free Full Text] 8. Paul Harvey, 1918–2009 http://www.paulharvey.com/statements.html 2005Accessed May 12, 2009.
Related Article
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Reply
- Harvey S. Hecht and Marc Colmer
J. Am. Coll. Cardiol. 2009 53: 2197-2198.
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