BROKEN HEARTS 115men with cholesterol levels "over 244 mgldL (milligrams per deciliter)
have more than three times the incidence of CHD (coronary heart dis-
ease) as do those with cholesterol levels less than 210 mgldL."15 The
contentious question of whether blood cholesterol levels could predict
heart disease was laid to rest. Cholesterol levels do make a difference.
In this same paper, high blood pressure was also demonstrated to be an
important risk factor for heart disease.
The importance given to risk factors signaled a conceptual revolu-
tion. When this study was started, most doctors believed that heart
disease was an inevitable "wearing down" of the body, and we could do
little about it. Our hearts were like car engines; as we got older, the parts
didn't work as well and sometimes gave out. By demonstrating that we
could see the disease in advance by measuring risk factors, the idea of
preventing heart disease suddenly had validity. Researchers wrote, ". .. it
appears that a preventive program is clearly necessary."15 Simply lower
the risk factors, such as blood cholesterol and blood pressure, and you
lower the risk of heart disease.
In modern-day America cholesterol and blood pressure are house-
hold terms. We spend over 30 billion dollars a year on drugs to control
these risk factors and other aspects of cardiovascular disease.^2 Almost
everyone now knows that he or she can work to prevent a heart attack
by keeping his or her risk factors at the right levels. This awareness is
only about fifty years old and due in large measure to the scientists and
subjects of the Framingham Heart Study.OUTSIDE OUR BORDERS
Framingham is the most well-known heart study ever done, but it is
merely one part of an enormous body of research conducted in this
country over the past sixty years. Early research led to the alarming
conclusion that we have some of the highest rates of heart disease in
the world. One study published in 1959 compared the coronary heart
disease death rates in twenty different countries (Chart 5.1) .16
These studies were examining Westernized societies. If we look at
more traditional societies, we tend to see even more striking disparities
in the incidence of heart disease. The Papua New Guinea Highlanders,
for example, pop up in research quite a bit because heart disease is rare
in their societyY Remember, for example, how low the rate of heart dis-
ease was in rural China. American men died from heart disease at a rate
almost seventeen times higher than their Chinese counterparts.IS