Hidden Epidemic: Heart Disease in America
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Chapter 2: Scary Statistics [14:17]

Heart disease now kills half of all Americans. How did we get here? One town in Massachusetts yields many clues.

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Transcript: Chapter 2 - Scary Statistics

Heart disease now kills half of all Americans. How did we get here? One town in Massachusetts yields many clues.

NARRATOR: Every 26 seconds someone in the US has a cardiac event. And once every minute someone dies.

STEVE NISSEN: Heart disease is the number-one problem in America. Disease of the heart and the blood vessels is responsible for up to half the deaths in America. So think about it. You take all other causes of death combined and they just equal heart disease as a cause of death.

DR. DANIEL LEVY: The vast majority of us, by the time we've reached a fairly ripe age, have advanced atherosclerosis in our blood vessels.

DR. STEVE NISSEN: And when you have the diagnosis of coronary heart disease, it's a diagnosis you carry for life.

NARRATOR: Despite the best today's doctors can offer there is no cure for any form of heart disease.

NARRATOR: Research is ongoing, and new clues are emerging which could lead to better treatments in the future.

DR. PETER LIBBY: We've undergone a revolution in cardiovascular care in the last few decades, where we have an understanding of some of the problems that arise and cause heart attacks, and we have therapies that can address them in a very effective way.

DR. STEVE NISSEN: But as far as we've come, with all of our technology, with all of our drugs, there's a lot we can't do.

NARRATOR: The fight against heart disease has been going on for over 60 years. It started at the time when almost no one realized how big a health threat it really was.

ELIZABETH G. NABLE: The story of heart disease in this country is a very interesting story. Post World War II, as our vets were coming back and re-entering the work force, the public health service made the observation that men in their 50's and 60's were dying of Heart Disease and we didn't know the cause.

NARRATOR: With the war over, federal money was freed up for projects at home. In an ironic twist, it was Vannevar Bush—the man who supervised the Manhattan Project—who pushed the government to do something about the new epidemic.

DR. DANIEL LEVY: 50 or 60 years ago it already was known that heart disease was the leading cause of death in our country. But almost nothing was known about the root causes of cardiovascular disease.

NARRATOR: In 1948, the US Public Health Service launched a study of heart disease that would become a landmark in medical history. At the time, it was completely new at the time—to follow a group of ordinary, healthy people for twenty years and search for causes of heart disease. The researcher chose the men and women of an unremarkable town outside of Boston called Framingham.

EVELYN LANGLEY: It was a beautiful little town, a very small population, maybe about 3,000 people, and no matter where you went you knew somebody. There were no busses, and most of the time you walked. There were theaters and restaurants, ice cream parlors. All those things were there back 30-40 years ago.

NARRATOR: Like many American towns in the late 1940's, Framingham was a small, middle class community. Its stable population made it an ideal site to launch the heart study. The hoped they would find clues in the medical histories of the people of Framingham—clues which might shed light on why so many Americans were falling victim to heart disease.

DR. DANIEL LEVY: When the study began in 1948, neither the study participants nor the investigators who were working here had much of an idea of what eventually would emerge from this town of Framingham.

VICTOR GALVANI: I took my first visit that open year, '48. It was outlined to us that they would try to determine what caused heart illnesses, and we all thought that we were fortunate to participate.

EVELYN LANGLEY: I thought it would be very interesting to find out what made everybody tick. My mother always used to say you got to give back a little bit of what God gave you, and I think that sort of stuck in my mind.

NARRATOR: In the early days the Framingham heart study was simple—a lot of questions about family history, diet, exercise, and employment, measuring blood pressure, listening to the heart, and some blood tests. And then, as the new study was quietly getting underway, heart disease suddenly made headlines.

Universal Newsreel: sound bite: A stunned nation hears that its president is stricken with a heart attack. The chief executive, ending his vacation, is rushed to Fitzsimmons Hospital where he is immediately placed in an oxygen tent. The president's son, Major John Eisenhower, and press secretary James Haggerty go to the president's bedside, from which physicians issue cautiously optimistic bulletins. Newsmen converge on the press secretary for information.

NARRATOR: President Eisenhower's heart attack was a dramatic and frightening event for the nation because at the time, most victims of heart attacks died within days.

DR. PETER LIBBY: Back in the post-World War II era the treatment for a heart attack was to put the patient to quiet bed rest for a period of weeks. We essentially would sit and watch the heart die, and try to keep the pain controlled with morphine and other kinds of analgesics, and hope for the best.

NARRATOR: It would take six weeks of hospital care before president Eisenhower could return to the white house.

NARRATOR: His heart attack had been a mild one, but even so, his survival was mainly a matter of luck.

DR. WILLIAM KANNEL: There was a concept that it was an inevitable cause of aging and genetic makeup, that if you had a bad family history, that was it.

NARRATOR: The original Framingham researchers refused to accept the simple explanation. Too many young Americans were having heart attacks for it to be a disease of aging, and may of them had no family history of heart trouble. The researchers began to ask probing questions. Were there specific scientific causes of heart disease? And if so, how could they find them? This was a challenge like nothing before.

DR. WILLIAM KANNELL: Here we were charged with the task of following 5,209 people over more than a 20-year period. We had to invent everything as we went along—the follow-up methods, the technology for analyzing data. No computers, no copy machines. We had a primitive punch card apparatus that did counting and sorting. It clanked away for eight hours to count and sort what a computer could do now in two seconds, and we were supposed to do this all by hand using carbon paper and electric typewriters and abacus for counting and doing statistical analysis.

NARRATOR: As the Framingham researchers entered uncharted medical territory, they discovered profound changes in the patterns of daily like in the US.

DR. DANIEL LEVY: In the era of post-war prosperity there was a great deal of emphasis on leading an easier lifestyle.

DR. DANIEL LEVY: We did everything we could back then to engineer exercise out of our lifestyle.

DR. DANIEL LEVY: We invented lawnmowers that, instead of being manual, push lawnmowers were now electric operated. We removed the old washing machine and wringer dryer, and replaced them with automated devices.

DR. STEVE NISSEN: Every family started to have a car. And the next thing we know, two cars. And when they wanted to go visit their neighbors who lived three blocks away would drive. Now previous generations, they'd walk those three blocks. May not seem like much, but multiply that across millions of people across the country.

DR. DANIEL LEVY: And the second thing that happened that made us a sedentary society was the invention of the television.

DR. STEVE NISSEN: Television is the great antidote to exercise, and it led to whole new terms like couch potato.

DR. DANIEL LEVY: Another important change was the change in the American diet. Having lived through the Depression, and then rationing that occurred during World War II, the post-war period was characterized by a sense of entitlement. We earned or deserve the right to enjoy a little bit of indulgence, and the entire American diet began to become a much richer, heavier, fat-laden and cholesterol-laden diet.

DR. STEVE NISSEN: We began to get fatter and eat more fat, and there's actually one more trend. During the war, the government issued cigarettes to every soldier. They were one of the few perquisites that a soldier could have, as they were—you're given, you know, a pretty good ration of cigarettes, and virtually everybody in the military smoked.

DR. STEVE NISSEN: And they came back and they actually introduced and women began to smoke, and before the war, women rarely, if ever, smoked cigarettes. We got to the point where we were fatter, eating more fat, exercising less, smoking more, and all of a sudden there was an extraordinary epidemic of heart disease.

NARRATOR: The Framingham researchers were making these same connections as they studied their volunteers.

NARRATOR: After 13 years, in 1961, the heart study reported its first major breakthrough. They isolated three key factors that could lead to heart disease high blood pressure, high cholesterol, and smoking.

DR. DANIEL LEVY: Perhaps the greatest legacy of the Framingham heart study was the early recognition of links between certain traits and characteristics and the development of disease later on. The emergence of this new concept of risk factors changed the whole equation of how we approach heart disease.

NARRATOR: The concept of Risk Factors—taken for granted today—was a revolutionary finding. Now that they new that blood pressure, cholesterol, and smoking were somehow connected to heart disease, they had to go on to figure out how, and why.

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