University of Minnesota
http://www.umn.edu/
612-625-5000
Menu

Igor Glasunov

Year: January 25th, 2005
Location: Helsinki, Finland
Interviewed by: Pyörälä, Kalevi

Abstract

Igor Glasunov is the central figure in CVD epidemiology in Soviet and post-Soviet Russia. Receptivity there to the ideas of prevention began from exposure of the dominant 20th century cardiologist, Alexander Myasnikov, to Anitschkov’s famed early diet cholesterol experiments, abetted by Myasnikov’s respect for the “enlightened” views of Paul Dudley White and his physiologist pal, Ancel Keys. The Soviet cardiologists absorbed every word during the White-Keys medico-political junkets to Russia dating from the late 1950s. Then they took action.

Glasunov indicates something of the top-down, “follow-the-leader,” off-and-on course of prevention researches in Russia. His account omits, however, the vigorous stimulus provided by the U.S. and the NHLI/Lipid Research Centers initiative of the early 1970s, which included sustained U.S.-Soviet collaborative research programs involving laboratory studies and trials on diet, lipids, and atherosclerosis in both Moscow and Leningrad. It also omits the 1970s initiative by teams of the U.S.-Soviet Health Treaty with collaboration on sudden death studies, which, in fact, failed in its population component. [ed. It was remarkable at the time how a centrally controlled Soviet state could not, despite its great authority, overcome the suspicion and non-participation of its individual citizens in surveys and surveillance tentatives.]

Russian contributions to CVD epidemiology were predominantly colloquial, developing locally relevant knowledge, methods, careers, concepts, and internal risk data. The Soviets had otherwise a wider political influence on CVD prevention due to their leading role in WHO policy and program initiatives throughout Europe. That influence was particularly focused on “comprehensive community strategies” through state medical care systems.

This interview between Kalevi Pyörälä and Igor Glasunov goes over most of the Soviet and Russian activities in CVD epidemiology and prevention research going back to Anitschkov’s rabbits. A major impetus to such research came from Myasnikov’s meetings and friendship with Keys and White, Myasnikov being the foremost cardiological leader of the Soviet Union. The Myasnikov Institute and the eventual All-Union Cardiological Center developed permanent divisions of clinical, experimental, and epidemiological research, with prevention activities assigned to Glasunov in 1967 and where he continues to function today.

He discusses the rising Soviet trend in coronary disease and CVD mortality, relieved only by two dips in mortality rates, one during the Gorbachov anti-alcohol campaign around 1985, and another with the economic depression of the mid 1990s. He attributes the unfavorable trend to failure to control hypertension and smoking, to the low priority for prevention in Russia, and to the current social currency of “personal” rather than “collective” responsibility for health.

The interview is mainly a chronology with anecdotes and personal descriptions of leaders and events. Glasunov indicates that his clinical approach was first challenged on a visit to Archie Cochrane in Cardiff, where he was admonished to conduct population-based surveys, which he subsequently mounted in the Soviet Union. [ed. He confirmed the story that Myasnikov had certified Stalin’s death and survived the subsequent pogrom but was not greatly involved with the leader’s care during life.] (Henry Blackburn)

Quotes

Atherosclerosis Research at the Myasnikov Institute

. . I remember that, of course, the prevailing ideas were those of Anitschkov who fed rabbits with cholesterol: [he famously said] ‘without cholesterol there is no atherosclerosis.’ But at the same time there were some other views. For instance, I was told at the Second Medical School, our Chief of the Department of Pathology was professor Davidovski, that he was a little bit contesting Anitschkov’s views and talking about some multiple causes of atherosclerosis and about the influence of environment and diet and so on. So I don’t think that among pathologists Anitschkov’s view was absolutely irrefutable.(2)

Oh, by the way, Myasnikov said that he proposed this topic of relationship between myocardial infarction, nutrition and cholesterol because he promised to Paul Dudley White and Ancel that he would do some work on that and he thought it was time to do some research.

…I said I would like to take the topic of myocardial infarction, nutrition, and atherosclerosis. So he said, “All right, fine, go ahead.” And then I had my supervisor, Professor Speranski, with whom we brainstormed later on how to deal with it, because there was no kind of literature in Russia, no kind of works, and so on. But one of the conditions for Myasnikov being interested in that was that he [had] some working relationship with Anitschkov I understood, particularly when he worked in St. Petersburg. It was Leningrad, of course, at that time. There was some exchange of works, ideas, and so on. So I think that he was actually a follower of Anitschkov’s ideas and he promoted a lot of experimental work at our Institute of Therapy. There were many dissertations done, you know, which included experiments on rabbits testing various kinds of drugs, vitamins, and so on and many other things. So he was rather conditioned in this work and related areas. (8)

So it was rather difficult to get research organized in Russia because the experience was nil at that point. I had to work myself through the literature and through some discussions with my supervisor who was Professor Speranski. I read whatever was available published in 1958 by Ancel Keys and Paul Dudley White from their visits to different countries, their study of coronary disease in general wards and some experiments of Ancel Keys, Francisco Grande and some others and so on. I think that at that time already the Framingham Study started also.

So I had to devise my own strategy of how to do the work and actually I chose ‘expedition work’ [surveys], I did personally, together with my assistant, visit four Russian cities. First I studied statistics and then I visited several cities where I tried to verify the statistics of mortality. Then I did my survey of samples in the cities near Moscow in central Russia. . . I compared mortality statistics for those cities and compared some nutritional data also from state statistics not so much on consumption on fats. Then on samples I did a survey of cholesterol, blood pressure, and tried to see if there was a pattern. There was some pattern, particularly differences were very great between Tallin and Duchampare. . . As for Tallin and Stalinabov they were my first two cities. . .it was all, you know, very clear and very poor. But then I added two other cities and they were not so clear, you know. . . . It was published in ’61. . . the total amount of fat also was lower, much lower than it was in Tallin. This was the very first [CVD epidemiological study] in Russia. . .And then I got a taste for such type of work, for epidemiological work. There were certain things, you know, which were not done according to all proper standards and so I will not go very far into details right now. So I suggested to Myasnikov that maybe I could have a unit in the Institute and he was favorable. (13)

There was at that time a person who worked for Myasnikov who was a head of a department of organization and pathology as it was called. He joined the Institute of Therapy and Myasnikov in 1960. His name was Rifkin. He was a very great promoter of…he valued very much the population studies and he sort of played a rather great role in sort of discussing and suggesting to Myasnikov that they should be expanded and they should be continued and so on and so forth. So that continued. And I think that in 1964-65 Myasnikov decided that it was time to create a Department of Cardiovascular Epidemiology. So he submitted a request to the Russian Academy of Medical Sciences to create at his Institute a Department of Cardiovascular Epidemiology. But unfortunately, due to various bureaucratic procedures, I don’t know, some other constraints and so on, that was dragging for about three or four years. But the Department of Cardiovascular Epidemiology was created in 1967 and I became the Head of that.(19)

[On my visit to the UK] He [Archibald Cochrane]was asking several times, “Why are you not doing random-sample surveys?” And I sort of was persuaded that we have to come to that and start to do that and so on. And so, in fact, our next big project was started as soon as we had the Department founded in 1967. We started to plan a random survey of cardiovascular disease and risk factors in a Moscow population and we started it in 1967 and continued in ’68. But in ’68 I went to WHO and the person who inherited my department . . and that survey, was Professor Metilitsa who completed it and published the survey – a random sample of Moscow population of one district in Moscow. So that actually was the first random sample survey in Russia, which was done at the end of ‘67. (19)

I was suggested to come for a meeting to Copenhagen and that was a [WHO] meeting on standard questionnaires, which…the principal person was Geoffrey Rose. So during that meeting – ’62 or ’63… it was decided that we should try to see if we can apply a standard questionnaire for studying coronary heart disease in European countries. So that was my first exposure to a sort of international environment. There was some other exposure, but to WHO environment and to some WHO international work.

At about the same time we had some visits I think in the framework of Russian-American collaboration, a visit of people from the National Heart Institute, and they were people like Dawber from the subject Framingham Study, Kannel,Zukel. . . So then certain collaborations . . . we were talking about comparing some electrocardiograms and we agreed and we did some comparisons of ECG coding, not coding actually but assessment. Because I remember Dawber was rather critical of the Minnesota Code, which was just published at that time. Remember?

So we did assessment in parallel of ECGs, which we had collected in Framingham and by us. We also exchanged some lipid samples. So it started this type of international conference. So after, we agreed with Geoffrey Rose and then other people. Other people at that meeting [were]: Kornitzer, I think Menotti maybe, some others I don’t remember exactly. We agreed to do this study.

We actually did this survey in various European countries and it was published in WHO. It was published in, I think, ’67-68-69. The first author is Rose. Its called, I think, “Coronary heart disease in European countries.” (20)

CVD Trends and Prevention in Russia Today

Then over the last 30 or 35 years you see the constant trend rising. It is rising. There were some periods of time when it went down. One period when it went down was during the anti-alcohol campaign of Gorbachev around ’85. And the second time it went down during economic constraints in Russia about ’94. But otherwise, if you draw the line it is always up[ward], with those two undulations.

The main reason [for the rise in CVD mortality] is that it is a very low priority for public action and because during the Soviet time public action was governmental action. Presently it is still governmental action because all the resources are still primarily there. The original resources are not easily available, not easily mobilized. But even if there is an intention to mobilize, still there is no public recognition of the problem.

So, in fact, we tried to work over the last 10 years together with WHO, with CDC, and so on, on developing a policy and strategy for prevention of cardiovascular and other noncommunicable disease. We worked on some educational program. We worked on monitoring instruments and so on. And it seems to me that, in fact, the armament is there, but the problem is that you can work out a strategy and methodology and have all the international experience with you, but you have to put in your own resources to move. And this is still not done.

And the reason is that during this . . last 10-15 years, health in general was rather low on priority agenda. And within the health agenda the prevention agenda or prevention issue is nearly zero. Nearly not attended at all. It seems to me that, you know, you cannot work without putting any resources into it. It has not worked, neither through public nor through the health services.

Its getting a little bit different. Over the last 15 years it is rising on the agenda. Health is much more on the agenda of the individual person and family than it used to be during Soviet time because it is now sort of more ‘personal responsibility’ and so on. So it is there. But, they don’t have supporting social structure, environment, you know, and opinion and so on.

I think it will be coming because we have the first maybe good moves such as some regulations, some passed in the parliament on smoking limitation and so on. I think that there is an interest to consider the health protection, health promotion issues. In fact, we are right now working on some thing there, but it is going at a very slow pace. And with such a pace I think there will be more increase, if you don’t catch up. (38)

Full Transcript Access

Full transcripts of interviews may be made available to those engaged with original materials for scholarly studies by contacting us.