Hidden Epidemic: Heart Disease in America
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Chapter 4: The Keys to Prevention [7:31]

The heart plays a central role in the human imagination, but it took data and analysis to expose the role of blood pressure.

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Transcript: Chapter 4 - The Keys to Prevention

The heart plays a central role in the human imagination, but it took data and analysis to expose the role of blood pressure.

DR. PETER LIBBY: When the heart works, we take it for granted. It beats regularly, it beats autonomously, we don't have to will it to act, and it's a reliable friend for most of us. And that may be one of the reasons why people could think that the heart is a magical organ. Even from the time of the ancients, the heart has been viewed as the seat of the soul. And many art forms have referred to the heart through the millennia, thinking of the heart as being a reflector of many emotions

DR. PETER LIBBY: When we're excited, when we're in love, when we're frightened, our heart speeds up and thumps like it's going to jump out of our chest.

Wizard of Oz: movie clip: No heart? No heart. All hollow.

DR. PETER LIBBY: And the heart figures very prominently in many songs.

Wizard of Oz: movie clip: I could stay young and chipper, and I'd lock it with a zipper, if I only had a heart....

DR. PETER LIBBY: The heart soldiers on for decades without our giving it a thought, but then it can be the root of our demise in just a fraction of a moment.

The Sopranos: t.v. clip: Oh my God, what's happening? Soprano, still V-Tach on the monitor. Oh my God, is he dying? Where's my mom? I don't know what's happening.

NARRATOR: In TV shows and movies, this is the popular portrayal of a heart attack. It strikes hard and without warning.

The Sopranos: t.v clip: Clear

NARRATOR: And there's a reason why this is such a favorite dramatic moment.

DR. STEVE NISSEN: The first symptom of heart disease, in around 60% of men, and around 50% of women, is either a large heart attack or sudden cardiac death. So more than half, overall, of people—that first symptom is a catastrophic problem.

NARRATOR: What's insidious about heart disease is that often takes a catastrophic event for a patient to realize anything is wrong. That's what happened to Evelyn Langley's husband.

EVELYN LANGLEY: He smoked a great deal. He did. He would come home, he would eat his supper, sit, maybe watch TV. But he'd always had two or three bottles of beer, and he smoked one cigarette after another. When he did stop smoking it was too late, and he died of a massive heart attack.

NARRATOR: In the mid 1960's, most people thought heart attacks came out of the blue, with no apparent cause. But at the same time, the Framingham researchers had gathered enough information to start challenging this belief. And now, they hoped they could find ways to prevent the disease.

DR. WILLIAM KANNEL: Preventive cardiology didn't exist when we started. And I think that's the concept that we had to get across that you shouldn't sit and wait for the catastrophe to occur, you should head it off at the pass.

NARRATOR: In order to do that, they would have to figure out the relationship between heart disease and risk factors. From the three that had been identified—high blood pressure, high cholesterol, and smoking—the first one that the scientists studied had previously been seen as no threat at all.

DR. DANIEL LEVY: When Framingham began collecting information on blood pressure, there was almost nothing understood about the risks associated with high blood pressure and many people at that point in time really held firmly to the belief that rising blood pressure was part of the normal aging process.

NARRATOR: At the time, medical students were taught that blood pressure that went up with age was the body's way of compensating for what was thought to be a normal narrowing of arteries in the heart. They even gave it a reassuring name Benign, Essential Hypertension.

DR. WILLIAM KANNEL: Now the term 'benign, essential hypertension' had a connotation, namely that it was not terribly important, and that it was essential for people's blood pressures to go up as they got older in order to profuse their organs through narrowing vessels.

NARRATOR: Before the Framingham study, the reasoning was that if you were 40 years old, for example, your blood pressure should be 140 over 90. At age 50, it should go up to 150 over 90, and so on. As high as 170 or even 180 over 90, depending on how long you lived. The Framingham Study, however, released a stunning new finding that told a completely different story. Blood Pressure that high was an enormous risk for heart disease.

DR. ELIZABETH NABEL: High blood pressure is really a silent killer because if it goes untreated for a long period of time, it will increase the likelihood that you'll develop a stroke or heart failure or other forms of heart disease.

NARRATOR: No one had ever proved direct connection between high blood pressure and heart disease before. And even more significantly, the researchers were also able to prove the other side of the equation. People with low blood pressure had a lower risk of heart attacks.

DR. DANIEL LEVY: It was then that new drugs began to emerge for the lowering of blood pressure. And with time, following these people, looking at who went on to develop cardiovascular disease, it began to become perfectly clear that lowering high blood pressure reduced the risk for heart disease.

NARRATOR: It was a discovery that turned the medical world of 1965 upside down. For the first time, there was proof that something specific—keeping blood pressure low—could prevent heart disease. This landmark finding would open doors to an entirely new approach to cardiovascular research.

DR. WILLIAM KANNEL: Well, I think, in fact, we have made a major impact on the way physicians approach the problem of preventing disease. We now are willing to examine unorthodox kinds of issues. So we're not as resistant as we used to be to innovation and new concepts.

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