Saturday, December 10, 2005

Preventing heart attacks

Most readers probably heard about the death this past week of former South Carolina Gov. Carroll Campbell, an exemplary political leader. The same day Gov. Campbell died of a heart attack, I received an invitation to attend an awards ceremony on Dec. 14 sponsored by the New York Academy of Medicine and Greater New York Hospital Association honoring Dr. John H. Laragh, Director of the Cardiovascular Center, New York-Presbyterian Hospital Weill Cornell Medical Center. Dr. Laragh is revered for his pioneering leadership in preventing heart attacks. Dr. Laragh also founded and led the American Society of Hypertension for years and oversees the editorial quality of The American Journal of Hypertension. Many Americans were introduced to his achievements through a cover story in Time magazine nearly 31 years ago, January 13, 1975. Despite our great advances in many areas of medical science, when it comes to preventing heart attacks, the promises of Dr. Laragh’s early research have been realized only inconsistently because “politically correct” decisions have misdirected our attention. Disclaimer: I’ve known and respected Dr. Laragh for nearly 20 years and am pleased and proud to have been able to include an affidavit from him supporting the Salt Institute’s petition to the National Heart, Lung and Blood Institute seeking correction of NHLBI’s improper characterization of the DASH-Sodium Study, which decision has been through a regulatory and now judicial process and will be argued before the U.S. 4th Circuit Court of Appeals in Richmond, VA on February 2, 2006. At the awards ceremony honoring Dr. Laragh next week, he will deliver a lecture on “The Laragh Blood Pressure Equation: BP = (body salt) x (plasma renin).” The message is as important as when he enunciated its principles more than 30 years ago: hormonal factors are crucial to understanding hypertension and the importance of focusing on heart attack risk, not blood pressure alone. I’ve extracted key, relevant quotes from the Time cover story, below, that make it clear that today’s controversies over whether it is a good idea to reduce dietary salt to lower the risk of heart attacks, reflect a turning-away from the sage insights Dr. Laragh contributed long years ago. It's a great story... and a cautionary tale of progress in preventing heart attacks that was undone by an unsophisticated, non-scientific, but "politically correct" assault on salt. Hypertension – Conquering the Quiet Killer” “Much of the credit for this successful treatment belongs to a perky professor of medicine named John Henry Laragh. Best known for untangling the hormonal relationships that control blood pressure, Laragh, 50, pioneered in the treatment of high blood pressure by founding the nation’s first hypertension center, at Manhattan’s Columbia Presbyterian Medical Center, in 1971.” … He had just announced his move to Cornell Medical Center. “Laragh’s move comes at an appropriate time. Medicine is better equipped than it has ever been to handle hypertension. Yet the disease remains perhaps the most neglected of health problems. Many physicians, in fact, still believe that moderately elevated blood pressure need not be treated. Laragh is determined to change all that. ‘Hypertension does not have to be the single leading factor in disability and deaths in the U.S. today,’ he insists. ‘We have the means to control it. What we have to do is use them. We’re ready for an all-out attack.’ “That attack has been a long time coming, for high blood pressure has been an enemy of men throughout recorded history. A Chinese medical text, dating back to 2,600 B.C. noted that a diet high in salt (now know to affect blood pressure) could cause changes in pulse and complexion.” … Since (1929 with the invention of the means to measure blood pressure, doctors) have become considerably more sophisticated about both blood pressure and its effects on the body.” … “To Laragh, the explanation is obvious. ‘Salt is the hydraulic agent of life,’ he explains. ‘It is salt that hold the water in humans, causes welling and a high fluid volume.’ This means an increased blood pressure.’ … “Until the end of World War II, doctors treated hypertensives, if they treated them at all, mainly by diet. Patients with high blood pressure were told to take off weight and lower their salt intakes. … Laragh, a cardiologist by training, “looked elsewhere in the circulatory system, and in 1955 he made an important discovery: he learned that increases in the blood levels of potassium can stimulate the production of aldosterone, an adrenal hormone that raises blood pressure by causing the kidneys to retain salt. “In the years that followed, Laragh made even more spectacular findings, which like so many other achievements in science, were serendipitous. Doctors had been aware of the role of aldosterone for some time. But they had been puzzled by the part played by renin, a kidney hormone produced in response to a drop in blood pressure. Laragh solved the puzzle. In 1958, he and his colleagues began treating a man with malignant hypertension, a rare form of the disease that is characterized by the kidney damage and usually kills its victims within a year. Tests showed that the man was, to their surprise, producing far more than the normal amount of aldosterone. This finding led to another series of tests that proved even more revealing. They showed that high aldosterone was probably due to increased secretion of renin.” … This discovery won Laragh a share of the Stouffer Prize in 1969 and “explained the hormonal controls of blood pressure for the first time. They also permitted the development of a renin profile – a computer-aided analysis of the patient’s hormonal output.” … “Laragh’s finding also cleared up another of the mysteries surrounding hypertension. Many hypertensives dismiss the seriousness of their conditions by citing the case of a relative who lived to be 80 despite a blood pressure that nearly popped the mercury out of the doctor’s sphygmomanometer. Laragh’s work indicates that these exceptions, which seemingly violate the rule that high blood pressure is dangerous, were probably low-renin hypertensives. Patients with this condition are less likely to suffer strokes and heart attacks than high-renin types.” The article also credits Dr. Laragh with discovering that “The Pill” with its estrogen-like ingredients, stimulated renin system and induced HBP and noted, in 1975, that the government was launching the “MRFIT” study, “designed to prevent heart attacks.” Interestingly, government analyses of this government-funded database have not identified that those on low-salt diets achieve any reduction in cardiovascular events or live longer. For more, see the Salt Institute website, http://www.saltinstitute.org/28.html and http://www.saltinstitute.org/healthrisk.html. For information on the Laragh award, contact the New York Academy of Medicine at http://www.nyam.org/events/?id=108@click=

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