Lars Wilhelmsen
Year: November 9th, 2003
Location: Anna Maria, Florida
Interviewed by: Blackburn, Henry
Abstract
Lars Wilhelmsen is a Swedish pioneer in CVD prevention research; and we touch on the origins, with Gosta Tibblin, of the Gothenburg Men of 1913 Study, which came as a challenge from their chief, the cardiologist Lars Werkö, to ‘do Framingham but do it better!” We hear details of that effort and its succession by a study with repeated cross-sections of men age 50, then later the addition of women, and then efforts at multifactor trials and surveillance, the gamut of distinguished Swedish contributions, most of which came from Gothenburg.
We touch on trends downward in CAD and stroke, despite upward trends in overweight, and the importance to these trends of both health promotion and cardiac care. He described the amusing coincidence: 30 year trends in observed CHD mortality rates fell 37% whereas the predicted decline from trends in multivariate risk score was exactly 37%!
We spoke of professional biases about the causes of CHD and the feasibility of prevention strategies, including the attitudes of Werkö, as with McMichael, which were not wholly science-based. But we spoke of the usefulness of even such emotional critics of the progress of prevention research and the need to reexamine one’s hypotheses, views, and paradigms.
We spoke of the relative diminution of younger people entering CVD epidemiology as a profession, and touched on the questionable outcome for the public health of current focus on genetic studies, and the reduced funding for population research.
Wilhelmsen had interesting data on a subject rarely treated, the difference in risk at a given risk factor level for those reduced by therapy versus those who had the lower ‘native’ level, indicating an ongoing excess risk even after ‘control’ by therapy, a concept much ignored in prevention and insurance projections.
We decried the medicalization of prevention and the Polypill concept and the steady advance of medical strategy over health promotion and the public health (HB).
Quotes
1. Lars Werkö came to Gosta Tibblin and myself. We were working at his unit in Gothenburg and he said, “You know Framingham, they have done this study and we could do it better. Think about it Gosta.” And he began to think about it and he came up with the view to study a single age group – men born in 1913. [Thus, getting rid of the age variable]
2. LW: This is the number of patients who have survived a myocardial infarction who are living in the community and this is from 1987 to 1997, which is a very real increase among men and among women it is also increasing. Nearly doubling of the number [prevalence]…of patients who have sustained a myocardial infarction.
[So prevalence goes up even though incidence is going down].
But the prevalence is of survivors. So they are better treated. So, I presume we got something out of this.
3. LW: What we can ask ourselves, Henry, whether it is all negative that we’ve had people like Lars Werkö and Michael Oliver and so on. I mean, it is good to have people who are criticizing or asking for evidence and so on. Then I think myself that Lars Werkö could now at this time agree that he has been a bit wrong on things. But he doesn’t do that.
[It is important that paradigms be overthrown and the only way they will be overthrown is by new evidence and new criticisms. I think the poly pill and the Adkins Diet are trying to overthrow the paradigm, and it will be a healthy discussion as a result of this.]
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