dr. Lewis Kuller, the father of preventive cardiology, has died at 88
dr. Lewis Kuller, a top epidemiologist and leading figure in preventive cardiology, could trace his interest in the field back to his time as a medical resident in Brooklyn in the early 1960s, responding to 911 calls when people died suddenly of heart attacks in at home or on the street.
Working at Maimonides Hospital and routinely assigned to emergency calls, he noticed that most heart attack deaths occurred outside the hospital.
“So we would go home and find people dead, or on the street, but especially at home,” said Dr. Kuller in an interview with the University of Minnesota Heart Attack Prevention Project in 2002, “and secondarily we would often go into a house and find people sticking their heads out the window with acute pulmonary edema.”
That experience led him to a career spanning more than 60 years studying risk factors for cardiovascular disease through a series of clinical trials, much of that time as chairman of the department of epidemiology at the University of Pittsburgh School of Public Health.
“Lew was on the cutting edge of what we should be thinking about next,” Dr. Donald Lloyd Jones, past president of the American Heart Association, said in a telephone interview. “He really understood the humanity of public health.”
dr. Kuller died at the age of 88 on October 25 in a hospital in Pittsburgh. His son Steven said the cause was pneumonia and congestive heart failure.
During the 1970s and 80s, dr. Kuller was the principal investigator in the 10-year Multiple Risk Factor Trial, colloquially known as “Mr. Fit.” Involving nearly 13,000 men aged 35 to 57, it focused on reducing the risk of heart disease through aggressive intervention by treating blood pressure and high cholesterol and counseling cigarette smokers.
When the researchers followed the men seven years later, those who received the special intervention had only a 7 percent lower rate of fatal heart disease than the men who received medical care from their usual doctors. However, the combined rate of fatal and nonfatal heart disease for those who received the special intervention was significantly lower.
Beginning in the 1980s and continuing for nearly 25 years, Dr. Kuller was the architect of the trial called Healthy Women Studywhich showed that menopause is a risk factor for cardiovascular disease.
“He was one of the first to say that menopause is a very critical point in heart disease for women, that up until that point they seemed protected,” Anne B. Newman, director of the Center on Aging and Population Health at the University of Pittsburgh School of Public Health, he said in a telephone interview.
Through ongoing studies in the 1980s and ’90s on the incidence of cardiovascular disease in people over 65 and systolic hypertension among those over 60, Dr. Kuller helped develop two inexpensive, noninvasive tests to predict heart disease and stroke.
Using new methods, the study found that people with significant artery clogging or atherosclerosis — but no outward symptoms of heart disease, such as chest pain — were two to three times more likely to die within a few years than those without evidence. condition.
“You don’t necessarily have to aggressively treat everyone with bad risk factors,” dr. Kuller told the New York Times.
One test used high-frequency sound waves to assess potential blockages in the arteries that feed the brain; another measured differences between blood pressure in the arms and legs, with lower ratios indicating the likelihood of extensive atherosclerosis in the peripheral arteries of the legs. Both tests are still being done.
In the brain-focused test, an instrument called a duplex scanner aimed at the carotid arteries measures the speed of blood flow; a high velocity indicates that the artery is narrowing, because the blood entering the narrowed channel is accelerating.
Lewis Henry Kuller was born in Brooklyn on January 9, 1934. His father, Meyer, owned a drug store; his mother, Dora (Olener) Kuller, was a kindergarten teacher.
He graduated from Hamilton College in Clinton, NY, with a BA in 1955. He received his medical degree from George Washington University in 1959.
After a stint at Maimonides Hospital, he served as a medical officer in the Navy from 1961 to 1963, then studied at the Johns Hopkins University School of Hygiene and Public Health (now the Bloomberg School of Public Health), where he received his master’s degree. in public health in 1964 and a Ph.D. on the subject in 1966. He was also a preventive medicine resident at Johns Hopkins.
Between 1966 and 1972 Dr. Kuller taught chronic disease and epidemiology at Johns Hopkins and preventive medicine at the University of Maryland. In those years, he published several studies on sudden cardiac death. In the journal Circulation in 1966, he and his colleagues reported finding that 32 percent of the deaths of Baltimore residents between 1964 and 1965 were sudden, and that arteriosclerotic heart disease accounted for 58 percent of them.
In another study, published three years later in The American Journal of Cardiology, Dr. Kuller called for “a program of primary prevention of myocardial infarction and sudden death or methods of early diagnosis and treatment” to reduce heart disease.
Appointed Chair of the Department of Epidemiology at the University of Pittsburgh in 1972, he was also a professor there and a frequent investigator in clinical trials, as well as the author of many journal articles.
“He had an inquisitive mind,” said Ross Prentice, a professor in the cancer prevention program at the Fred Hutchinson Cancer Center in Seattle, “and a willingness to study the literature, not only in areas where he might be working, but he would send me things every few week – ‘here’s what I found in this diary’, he would say. He had great intellectual strength in his 80s.”
Among the numerous studies of dr. Kullera was one of a small group of people who found a link between artery-clogging calcium deposits and the risk of dementia in people over 80.
“If delaying or preventing atherosclerosis resulted in reducing or slowing the progression of brain disease and the subsequent onset of dementia,” said Dr. Kuller online publication from the University of Pittsburgh Medical Center in 2016, “then there is the potential for a very significant impact on reducing the majority of dementia in very old age.”
Besides his son, dr. Kuller is survived by his wife, Alice (Bisgaier) Kuller; his daughters, Gail Enda and Anne Kuller; and six grandchildren.
In 1985, Dr. Kuller is “Mr. Fit” study became a cause for fame when an ad published in 25 newspapers and magazines by the tobacco company RJ Reynolds used it to say that it had failed to find a clear link between smoking and heart disease.
dr. Kuller told the Washington Post that the study did not test the link between smoking and heart disease because the evidence for that link is a long-settled scientific question.
In response to Reynolds’ advertisement, Dr. Kuller told The Post, “It’s like an ad that says, ‘Eat a carcinogen — we need more time to think about that issue.'”
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