The First Authoritative Recommendations on Arteriosclerosis 1958
A Statement on Arteriosclerosis:
Main Cause of “Heart Attacks” and “Strokes”
National Health Education Committee:
- Paul Dudley White
- Howard B. Sprague
- Jeremiah Stamler
- Frederick J. Stare
- Irving S. Wright
- Louis N. Katz
- Samuel L. Levine
- Irvine H. Page
(Supported by 106 members of the American Society for the Study of Arteriosclerosis)
Mary Lasker’s Health Education Committee was chaired by herself (Mrs. Albert Lasker) with Jane McDonough as Executive Secretary. The 28 members of the full committee included the wife of the U.S. vice-president, Mrs. Alben Barkley, Michael DeBakey, John Gunther, Florence Mahoney, Jessie Marmoston, Jeremiah Stamler, and Frederick Stare.
“To aid in public education on the progress and needs of medical research through the compilation and dissemination of factual information on the major killers and cripplers–heart disease, especially arteriosclerosis, cancer, mental illnesses, arthritis, neurological diseases, blindness, and other major disabling conditions, and on the rehabilitation needs of people suffering from these disorders.
To inspire public understanding of the human and economic gains to be obtained through increased medical research by all health agencies” (Report 1958, 22).
“This statement of guidance summarizes useful information on these points. While it is realized that a definitive statement may be modified, at least in part, by future research, nevertheless, it is believed that on the basis of current evidence and experience this statement provides information that will prolong the life of many citizens at this time” (ibid.,2).
The report then lists, illustrates, and discusses, in the following order, the risk and the behavior associated with:
- Overweight (illustrated by a pear-shaped woman and an apple-shaped, middle-aged, bald man)
- Elevated Blood Cholesterol Level
- Elevated Blood Pressure
- Excessive Cigarette Smoking (“excessive” undefined)
Physical Inactivity did not earn a number but the accumulated evidence about its risk was quoted and referenced in explanation of the statement that, “hard work itself is often wrongly blamed for this disease” (ibid.18). In the same afterthought came a quote on psychosocial factors from WHO Technical Report Series 117 of 1957: “The widespread belief that psychological factors (stress, strain, and mental tension) play some part in the genesis of ischaemic heart disease appears to have as yet no scientific basis” (18).
The committee statement concludes with data on prevalence and estimated economic burden, gender differences, and a list of the two greatest needs in arteriosclerosis:
1. More funds for research, teaching, and education, and 2. a “simple, accurate method for the early detection and diagnosis of arteriosclerosis . . as well as better methods of treatment, cures, and methods of prevention” (ibid.,20).
This seminal report owes much to the enterprise of Mary Lasker and Paul White. It was unique and of historical import because it was early, immediately following the development of evidence from the first prospective studies; because of its putting obesity as the number one risk factor yet not mentioning diabetes; its condemning of only “excessive” cigarette smoking (and not defining excessive, but referring to the landmark first report of the Study Group on Smoking and Health in Science 125:1129, 1957); its mention of early evidence on the role of physical activity; its downplaying of the popular notion of the importance of “stress;” and its detailed literature references to the “best evidence” in support of each recommendation.
The statement was widely hailed by preventionists of the day and equally widely attacked by those not convinced, along with numerous special interests. (Henry Blackburn)
A Statement on Arteriosclerosis. Main Cause of “Heart Attacks” and “Strokes” National Health Education Committee, Inc. 1958, 135 E. 42nd St. NY, NY.