International Cardiology and Research
by Ancel Keys
Presented 9 December, 1955 before the American College of Physicians at the Harvard Club in Boston
In December 1955 Ancel Keys was near completion of the series of informal surveys he had made with Paul White, Boston cardiologist, among cultures contrasting in habitual diet. In 1957 he finally set out to design and undertake the systematic comparisons among 16 cohorts of the Seven Countries Study. He had just hosted in Minnesota a major conference on the epidemiology of cardiovascular diseases (CVD). Here he puts forward his early findings and guiding ideas about their association with variations in lifestyle, expecially with diet and blood lipid differences among populations.
The following paragraph indicates his early grasp of the more efficient approach to comparative analysis of population characteristics and disease:
“Elementary mathematical theory shows that the solution of a multivariable equation is least diificult, and most accurate, when the widest range of values is available for the several variables. But in any one environment and culture we are restricted by homogeneity. Clearly we should seek out, whereever they may be, the extremes of these variables, and their combinations most favorable for analysis; populations where X is as big or again as small as it can be, where a big Y goes with a little X and vice versa, and where Z is a constant or negligible; where the force of each can be evaluated and given its place in the etiology of the disease.”
The next paragraph, also from this 1955 Harvard presentation, exposes with equal clarity Keys’s view that, recognizing individual genetic differences, nurture (lifestyle and exposures) is a strong influence on individual risk of CVD and probably the major determinant of population and cultural differences in chronic disease rates:
“In the genesis and development of these diseases we are mainly concerned with the factors of nurture, of the environment in its broadest sense, for only through these can we hope to achieve control and prevention. This is not to deny the boundaries set by the nature of man and the limiting factor of genetic endowment. . . . .
I prefer to believe the Bantu rarely has a myocardial infarction for the same reason he rarely goes to Harvard; he doesn’t live that way.”
Also found in this 1955 presentation is the idea Keys shared early with Paul White, the cardiologist and Executive Director of the Advisory Council of the new National Heart Institute. They found that international medical research was not only a crucial complement to clinical and laboratory studies but a most effective diplomatic strategy, a stimulus for peaceful exchange and collaboration. (Henry Blackburn)