The ‘Great Leap’ post-war of CVD Epidemiology to and within Europe
Marcel Kornitzer traces the background knowledge in Europe leading to the origins of formal CVD epidemiology in mid-century, particularly in respect to continental clinical and experimental contributions. He cites:
- the complementary theories of atherosclerosis from Virchow and Rokitansky,
- the diet experiments of Ignatowski and Anitschkow (1909-12),
- the study of diet effects on serum cholesterol levels by Bacmeister and Henes (1913),
- Muller’s 1938 clinical features of angina pectoris in hypercholesterolemic families,
- the 1910 recognition of acute infarction with survival by two Russian clinicians, Obrastzov and Strashesco, and
- the experiences of Dutch ‘Marco Polos’ DeLangen and Snapper who reported on cultural differences in diet, lipid levels, and coronary disease.
Kornitzer emphasizes how medicine on the continent was stunned by the “horrible natural experiment” of starvation during and immediately after World War II but nevertheless cognizant of its associated dramatic decrease in clinical and autopsy findings of atherosclerosis. Because the post-war intellectual preoccupation of Europe was mainly with healing its wounds, the advance of CVD epidemiology in continental Europe was delayed compared to North American pursuits.
Parallel developments of the MRC Social Medicine and Epidemiology Units in the UK and the vigorous push from the teaching of epidemiology and advances in design and operation of cohort studies and trials from the London School of Hygiene and Tropical Medicine had wide effects both local and continental.
According to Kalevi Pyörälä, a ferment in Scandinavia also arose in the early 1950s, with the conversion of pulmonary to CVD screening activities, the Leren Trial of lipid lowering in Oslo, the Finnish Mental Hospital Study of diet, and the pilot studies of Finnish cohorts in the Seven Countries Study.
Kornitzer and Pyörälä both give much credit for the international “Great Leap” in CVD Epidemiology to the collegial relations and exchange among North American, UK, and European physicians and researchers, especially during the seminal early meetings and technical reports of WHO and the International Society of Cardiology (ISC) Research Committee. The 1950s WHO expert conferences were critical to the first exchange of ideas and methods. Later meetings sponsored by WHO and the ISC International Seminars in the 1970s and 80s, and beyond, were importantly devoted to collaborative international training and operations.
For example, Kornitzer tells this story of the beginnings of the European segment of the WHO Multiple Risk Factor Trial in Industry, which occurred at the 1970 ISC Blessington Seminar:
“In August, 1970, I attended the "Ten-Day Teaching Seminar on Cardiovascular Epidemiology" in Blessington, Ireland, a great experience both at the scientific and socio-cultural level. During one of the afternoon breaks, Prof. Geoffrey Rose proposed to me a bicycle ride around the local reservoir, saying that he wanted to discuss something with me. I felt honored and accepted what would become an historical ride.
Let me start by saying that my level of physical conditioning was rather low at the time, and after 15 minutes up and down dale, I was puffing along mightily behind Rose. He told me he had started a multifactorial prevention trial in the UK by pairing off 24 factories, one experimental, the other control. But he calculated the statistical power of that design too low to show a significant reduction of CHD risk through modification of the major coronary risk factors. He wanted to extend the concept to other pairs in other countries and asked if I would be interested in developing a Belgian arm of such a trial.
Riding behind him in great difficulty, I was grunting the whole time: "Ugh! Ugh! Ugh!” which he took for positive replies to his proposal!
After about 30 minutes he turned his head, realized the situation and, elegant as always, said, “Marcel, let's go back. I feel a bit tired.”
That day the WHO European Collaborative Trial in Multifactorial Prevention of Coronary Heart Disease" was born. Later on, Poland, with Stefan Rywik, and Italy, with Alessandro Menotti, joined the club.
WHO-appointed ‘regional representatives’ and participation in these early conferences and expert groups were clearly important to the dissemination of concepts and to the opening of career opportunities internationally in CVD epidemiology and preventive cardiology. (Henry Blackburn)
Marcel Kornitzer, in an interview with Henry Blackburn, 10 November 2003, History of Cardiovascular Epidemiology Collection, University of Minnesota.