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Council for Tobacco Research

Report of the Scientific Director [St]

Date: 1965 (est.)
Length: 40 pages
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25 Sep 1995
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Little, C.C., Ctr
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ANNUAL REPORT
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002
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SQEHTIFIC ADVLSORY • SOARD io Tita Cauadl toc Tobaoco Acscancb-U.S.A. KENNETH MERRILL LYNCH. M.D., Sc.D., LL.D., Chain+wn Chm~ a+d ProJsssar o! P bfodical Cokr ot Soo=b C"'diaa, ar3atoa, South Caroiiaa HOWARD B. AlvDl'iRVONT, Sc.D. SckulJk £.alar. nn Jcataii of t3o Natiooal Canorr lnstizsua Ber+~ad.. xa~taaa RK~iARD J. BINa. M.D. P,olcsaor aad Chiairn.an, Dep.rtmaot oc JvLodjcino Wayaa SWO UalvaajRy CoDtyD ot Uodiciae. Dctroit. MzLipn McXEEN CATTEiI., Px.D.. M.D. ProlcaAO. EnwrUaa of PbarWocVloV CocacA Univasity Medical Ccl)c=c„ Naw York. N. Y. LEON O. JACOBSON. M.D. ProJuror and ChaLnran. Department o[ Mediciae Univcrsity of CLiago Dln+aor. Arpaao Gnctr Research Hospital, Cbicago, IIlinoi. PAUL KO17N, M.D. Asaoclatc Diwor for Ficid Studicu Natioaal Gaccr Institute, Bctbcsda, Maryfaad CLARENCE COOK I.rPfLE, Sc.D.. LL.D.. Lrr.D. Scwuijtc Dinrtor, The Council for Tobacco RescaccA--US.A. Dirsrtor Eine.itxr. Ro.cot B. Jackson Memorial Laboratory, Bar Harbor. Ma1oo STANLEY P. REIMANN, M.D.. Sc.D. Dlrector Ensssitur, Tbo InstiWtc toc Cancu RacucL PbitsdclPa+s. Pcoasytranis W1LLiAM F. RIPNHOFF, Jx., M.D. Prnlessor Emerltaar o/ S+srcrr Johas Hopkias Unirctsity Scbooi o( Medicinc, Baltimoce, Maryland Edwin B. Wilson, PtLD., LLD. 1819-1954 Dr. Edwin Bidwoil Wi}son, wbose carecr spanned the Aclds o( maibcmatio, paysica, acronautics, statistics, epit3omiolo" and socio3oSy died on December 2E, 1964. Dr. Wilson bad served as a mcmbet ol the Scicntibc Advisay Board to Tba Council toc Tobacco Rc.acarch--U.S.A. since 1954. He was a pno[wor emeritus c[ vital statis- tics of the Harvud Un}vcrsity Scbooi o[ Public Hcalth. Dr. Wilson bad boca a vice president a( the Natiooal Acadcmy of Sci- caccs and edited itt Pra.ucdtntr fmm 1915 until his dcatb. Ho tau=Dt matbematiCa at both Yak and Harrard and was chairman of the Dcpartnoent of Pbysla at the Masaa- cltiusats Institute ol ToclmoiM. Dr. Wilson scrved as a caasultant to the OIBce o( Naval Rcscarcd for many ycats and was a recipient of the Navy's DistinjuisLod Cldliaa Savico Award. He was a pst ptr.idoot o[ the American Statisrial As.ociation, tbe Social Scicnco Research Council and tDa American Academy o( Arts and Scxncas. ROBERT C. HOCKETT, Px.D. J. MORRISON BRADY. M.D. AtaoCiau StitntlfiC Dlrstlo+ As.tac'lote Scitnli(ic Dirtctor
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Tbe Progress of Research . . . . . . • . . . . . . . 5 Abstracts of Rcpocts . . . . . . . . . . . . . . . . 26 Psycbo-Physioio:3cal Studies . . . . . . . . . . . 26 Gcdiovascutar Dbcase . . . . . . . . . . . 30 Carcinovrnais 9tudie. . . . . . . . . . . . . . 41 Other Cancer Studjo. . . . . . . . . . . . . . 47 Pu2mooary PAysioiop Studies . . . . . . . . . . 48 (bcmiairy 4 Biocbemhtry Studka . . . . . . . . . S I pAarmaodM A pspcbo-pbartaacciopr Studies ..... 55 Othcr Studics . . . . . . . . . . . . . . . 56 Recipients of Grants . . . . . . . . . . . . . . . . 58 I i The Progress of Research The Council foc Tobacco ReseurL is oommittod to a oondaufag and up.ading program of expaimcatal and dWcal trtuddioa a( human Q"tsoaaos. The Councii's progxm, tbarloco, h primarily o00 of med3aa raearcb, wAich spreads over [nto the various selated branches o[ t+c,knots that can bo brougbt to bear upon problema o( distase. Wkafa tno broad bold of moQl- cine, emphasis is placed upon etbbp, tLat k, upon the factocs, }aflneacc. aad agents, both internal and oatr+cnal, that may have .omething to do with the uusation of discaat, rather tban upoa tuothods of tteatnueat or cttra. TLis empbasi. upoa di.cau goacsit Is duo to oonv3otion tbat pncnnctMs aso.- suna will probably do most eventually to rodut:o dto toa o[ tbo.e d•iscam that aro now our greatest killcn. The selectioa of diseases for study is based on the rektPve pncacq; ind- dcace of the discasc as well as its Importance as a cause o( mortafity, anQ the degree to which it has bcca reputed to be asaociated statbticaay with tobacco use. The various discasa which bave been tc3octed for study aII belong to the broad catcgory of coostitutional diaettaes. TLae boclude, among others, the cardiovascular discascs, lun= anocr, akca atd the .arious c3uunk rupiratory ailments. In such diseases external agnts arc ditllcutt to idwtity, often complex or multiple and of minor importance or tvea impotcst unless and until tis- sues o( Lhe host organism respond by reactions cLuactaiatic of their basic and predetcrmincd bioiogical and biocbctakal makeup. Ttw situation is in marked coatrut with that found ht the infectious discascs where ooe or more spocitsc external agcats ar+c involved. These in- fcctious diseaac agcnts invade the cells and tissues as enemy alicas and they remain so, impairing, killing, destroying the ceZa and tissucs wLicb they invade. The invcstigator an develop tocbniques to isolate them and to inactivate or destroy them in turn without harta to the body cells. In the constitutional diseases, the situation is different. Canoer ccUs anc a part of the body and arc not alicn to It. Tbey am modified but are very much at home. Similarly, the aging oclls of the circvLtoq system uo still qpdy ath, impaired and weakened in function but uiA not stranScrs. 5 a -~ .~.. ..,.. ..~~...
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these alternative qucstions and the explanatory hypotheses which they sug- bcst had boca so clearly focmulated, sincc hindsight is ro notoriously supcrior to foresight. Ncvcrtbclat;, ln ctioct, the 6rst ot thao tLroc possibilitia was adopted as a working h7Potbot3.. The physiological=spocsa o( ulcer etlojoty, though certainly not fully undcrstood, have becn elucidated in aomo part.<u Presumably they are much better understood than the etiology of eancct. Hcnoe experiments could be devised to observe whether nicotiao or snwiunj can influcnoc these known physlolosical factoas. Gastric ulcer is usually associated with ooemal or reduced acidity and volua:K of gastric secretioo aftrr fastini, whereas duodenal ulcer is gcn- eralty associated with inaocased acidity and volumo ol Pstric secrction after fasting. Hypasccraioa in the pstric ulcer patient during stasis of food is attributed by Ikagstedt and otbers, including Fdkin, to hormonal (gastrin) stimulation, and that in tbo duodenal nlccr patient to nervous (vagus) stimulation. Since ahaatiom in gastric aeenctlao probably IaHuence the course of peptic ulcer, the literature on ttportod eliects of smoking on gastric secre- tion would appear to be rokvant. Howevcr, the existing literature, when the Council program bepn, was contradictory. Moat of the rcported studies rather obviously lacked adequate controls and neglected rekvant variabla. New studies werc therefore sponsored by The Council in three centers under the direction of qualified zacientific investigators. Non-smokcrs, habit- ual enokcrs, noemal aubjeets, and persons with a history of duodenal ulcer wcro includod, and the obarratiooa wert well controllcd. In these studia the v,olume, hydrogen ron concentration, free ac1d, peptic concentration or peptic output of the gastric .xrctions showed no significant or consistent ebanycs during or folbwina tso smoking of cigarettes. Gaattic nsotiGty was iavatiysted and no aigrtificant changes found in the number of dtuatiou of lntraEsstric balloon pressure waves following cigarette smokinL Intragastric tempcratura .rcre measured in twenty patknts with duo- dnul ulcer, dividing them into "smokess° and controls. No significant intra- =astric tempaaturs caantts wae found to be induced by smoking. On account of oontradictocr reports on pepsin and pcpsinogcn secre- tian as possibly related to uloa, several studies were made in two centers. A study of pepsinoScn excretion in twenty patients without evidence of jastroiatatiaa! diswe showed the mean diAcrence in the concentration of 0xk.;p4odA. L tt. TAr LrAorrnr.lr oJ Ga.atic .nJ Duodrnol U/crn. Symposium ow t/ic >1lawaacwww o( Pcptic Uksrs. Aaw.ls o( Ms Na. York Acadcmy o[ $CKnccs, Y!. Act. 1, paw t 10, 1942. i pepsinogcn in plasma during the noo-smokiaj as eomparod with the smoking period was a small but statistically significant doutat+e in the pepslao=at level during the smoking periods. Gastric pepsin and uropcps'tn in patients with duodcnal ulcrr ecre oom- parod before and after surgery. It was concluded thu frauional dtaamina- tions of uropcpsin do not accurately rsffoct gastric peptk activity and should not be used to replace gastric aecrctory atudks. Another investigator musurod gastric pepsin as well as urine anA saum pepsinogen in ten volunteers. Continued smoking by habitual smokess and habitual non-srrwkcrs produced no oonsistcat changu in these subjects as compared with the output during periods of tob~cco abstinence. The possible effects of smoking on dissolved gastric mociaa and on viscosity of aastric juice in patients and In normal oonttofs was Investigated. Under the conditions of the study, turtokin j did not significantly alter eith« concentration of dissolved mucins oc the rsl.tiro visoodty of pstric juka The Council has not so far undertaken any exteasire cliakal studies to detcrmine the possible influence of smoking on the outcome of treatment rcgimcns. Existing literature on such work is not only limhed but published studies reveal a lack of controls, particularly with respect to food intake, among smoking and non-smoking paticats.m A Council-sponsorod study of ptoion6od cigarette smoking in two duodenal ulcer patients, measurod gastric acid aeaetion. One subjoet fol- lowed the usual pattern of nocmal variation in gastric acidity without definite trends related to smoking or non-smoking. The other experienced a sigstifi- cant increase in acidity when smoking was discontinued. The effects of continued ciga; smoking were ob4aved in five habitual smokcrs and five habitual nonamokas. One non-tmoket experienced a notabk decrease in gastric acid secretion after thrce weeks of cigar smokinj, which continued during the two week post-control period of non-smaiting. In general, there were no significant trends of change in pstrk activity or in pepsin in these subjects that could be related to t!>cir smoking oe non- smoking. 'IZtis program would appear to have been rather comprtLcasive insofar as present knowkdgc of physiological factors involved in peptic ulcer genesis is concerned. It has failed completely to suggest any aaocLanism by which cigarette smoking could contribute to production of the diaeaae. Of cotn3e, thcoretically, such a mechanism may still exist, but until some new concept of physiological facton in ulccr ctiobjy is advancoQ, It appears difficult to devise additional experimcnts that might be Illuminating. The fiat working 0N)oil, R., loota, F. A. and Py`cm, p. /CAlrvi of Sn.oAlOW ow nIr lrolwdon .n1 Al+Inun.ncr o/ (:..ii.r an1 Uralrnrl Ukrra.'the tAocns, l'6.57, Matc!• 1131. 8 9
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~ hypothcsis has rtxeivad no support from this woct and thcse investigations have sot yielded any pwcticsl suggcstiom fac ulcer prcvcntias through asoddicatiocs of tobaooo uas a adtaatioa of tobacco pooducts. While, tiroas tbe staodpoint of pttto l4c, the first workinj hypothcsis hai twt baa dispr+ovod, k laa bot:a wcaitptpd by lack at support trom cx- traa+e patineat ttd+dy. tieaca, it boeame Masoaabb to ooa:id4r tbe second bypothais: Doer beary ci4,ornr aAwklat ailotr tbr srtstattc:t+ 01 avwstfttdJonaf 9ual(tiu thot matt a pa-ma wtxxptfNt Io trletir ot' tlo wtritet Afm adop( a patterrt oJ lilt hob1v tAm maat to britt; ow abs jtacatrl it is widely belie.ad tbst peptic t+btx lt to t+ome coosidetabk degree a "psyrbO.or.atx" disasa itr wbkb aScoakally detcrtnlood pcodispo.ition taakea ot:rtain kit.da of pcr.oas tespo.d to attaia dcg+oa or kinQs of st4,ua by developinj doer.at Preswsabty tRrus wrould tsot lodoco ulcer without some degzec d pcod"apositia. aad the psodKpoa&3oo alooo would not proo- duoe tbo disease without sotoe de=roo of tttrcat abova• tl>e threshold of the iodiriduara tolerance. One.rould ezpoet a raiproeal ydatlooship: the higher the ptedi:spositioa, the lat tAa sszosa roqpiro4 foc pcocipitatioa of overt d.we. These conoepts, which have beeu developed to quite a sopAisticatcd kvd; O) ue ia haruway with tbe second working bypotheab and provide a po.stble basis for k. ., It has also boeu suggested tsuay tLnea that some cigarette smokcrs may purwa t}a{s pnctice as a respoma to atras and frustntion, or in the search tor rdid firom such. IL this event, tbelr Srnetic or cowtitutional abilitia to htmtsc txrea or frostratioo might be eapoctod to deta'raine or iaeuwce their tsood or dtsi:+c so smoke. Combioi.S tbc.e two concepts, it appears eatird) reasonable to postu- late tLat pccaoas who arc so constituted as to be likely andidata fot ular might also be d a type espodalFj 'taciined to seek siras-tdkf through cig- arctte srnottiq. Soch a sittaatiom would be tacpoctod to produce a statistical assoaatioo bct.raa smoth.= aad ular atostaliry. Yct, ia this casc an asso- duiom would not ieopty th.t smotin=mado any coatribution to uusation of tbe disesae Ou the ooarary, it.woW asggCSt tbat i( smoking is truly clioctive in reducing stras, it aalght so tJM.f ssAaK atataAr belp tbo.e p[sdisposod to nioa ta dcfetd theat.dvcs a=aitrt Kress iaQneooa and thus exercise some preventive eflats. This it a oartoitaq of abo atoood bypotbesis but is not •ooewuy to its naihatias. 'IU aooond UJ potbesis depends only upon the 0/Akaaad.r, F.,aacow, C. aad Lrny IL i. 7A. /ryfr.wce oJ IrycAoloslc F.ciors Upa ConniiMraMw.J DiihMi+sca, d S)syoda+w. 'i1s tsycloanvytic Q~++cscdY. !, 301, U]4. 10 postulate that uker susccptibecs seck stress rrlief through tmotint, whether or not they achicve it. It they acbieved compleu relid, presumably the uao- ciation betwcen ulcer and smoking wrould disappcar altogether. The question whether smoking aifords some dcgce of relied may be ttwcepttbk to invcsd- gation through a suitably designed study of aloa6prooe paroos divided at random into smoking and non-aaoktnj groups totr compadsoo. Several Council studies bear upon the questlon of personality in rolatioa to smok- ing, and upon its possible "tranqtuldW a$octt, at tlia le+rd of psycho- PhumacoiofJ'• Tat of the second hypothais, that tslca smotptibks u a poop ttuT rcsort to relatively heavy cigarette smoking at an eacape from stress, has beaun, but presents some ditscultics. Stress k not esry to dcline or measune and, notoriously. "boe man's stress may be anotbera pieawra" It appaa necessary to arrive at a method of describing ac identityiag the u3otx-pr+one person in terms of some group of physioiopcal, biochemical and/or psycho- logical characteristics that can be tr+casured. An jdcal proGle should make possible the reliable identification d the t»d!v{dwd who is ratbtx highly susceptible to ulcer under relatively "normal" eaviroamaual eooditioa.. (Presumably any person, even a highly resistant ooe, could develop ular unck: :.urcntc conditiona. ) shon of the kkal, which may not be attained for a long time, is, tho developmait :./ a pro(1k capablc at least of sep.ntlag a group of the «la- tively susccptiblc f:om a group of the relatively uaauaceptibk with a mini- mum degree of overlap. If the susceptible group then oontaiacd tooM or heavier cigarette smokers, whether or not they had erer bad alca, the hypothesis would reccive support (tbouth hu+dty pr0o(). Developmeat of this type of profik appears to tie within tbe rutm of attainability in a tsot- too-distantfuturr. Thcre arc many other diseases, notably eardlovasealar conditions, for which similar criteria for idcntilication of the big}tly wsecpt>aie waa3d be very desirable, and many ctiorts to establish such ptdfks aro underway modtr various auspices. Studies of this kind aro atlll }n their 6tfaat)r. None has yet been highly successful but slow, steady progress Is beinS made.'TDh type of research must certainly become a majot effoR in The fbtm+e ainoo it appears to offer the best hope of reducing the toll o( those slowly-devdoptnE ooo6t- tions that are pracntly the jadinj uwa ot akkners atsd dcatb. A vast and almost uncxploitod opportunity Iia hare whbin tbe nealm of biochemistry. The relative levels and activities of the various enzymes and enzyme systems as revealed by examinatlon of tu'ino, b{ood, saliva and freshly excised tissues seem likely to bcooax the basis for daeripiive profi3cs that will reveal tendencics and predispositions to imbalance evea lon j befoc~e I1
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` actual diacase devclopt+. Such biochemical ptofiles promisc to become an eventual strooa disysostic rtsotnco and a major juidc to cnnsiitutiotul dboasts pnereatioo. It the uan of . ulecr, o.o naw appeo.clt toward the devclopmertt of taoaas for ldwtif)riaf tba prqdirpaas ~w been t+ousbt thrnu jh taudia of the tastti acaaa It has been sbo+rt; that Vcndic [az/ocs ptodominate in determinin j taste sensitivity to 6-+rptvpyhbiouradl (PROP) and evidence adduced that this wicasuable e6ataperistic somehow ro;docts the basic biochcmical makcup of the human body. It had beoa po.tulatod also that these diffctw>ccs in acnshivity to bitta taste stl#t eocrdate with the incidence of «rtain gc- tietjc di:cascas and some ooaftmatocy evidence bad been collected. A Council study inratitalod taalts aensitivity to PROP in duodcnal and psbrie uloer patients In ootstpatLon with normals. Significant diIIereocea wcre found bet.roca the d.odoaal ttloos and the =aauic uloa subjects. The former wa +a taom sensici.e tstttas. Subjects having both uloeri resembled the duodettal group. Gastrjc ttker patients tcndod to be signifkantly las aensitive tw PROP while dtsodenal uloa patknts and those with both ulcers showed aSresacr tasta sensitivity far PROP than normal subjccu. The data thaefora aupport the eoscept that dt+odenal and gastric ulcer are diffcrent di.ease.,, aad sagyest a constitutional basis at laat for the latter. They also supcat that measurements of taste swsitiviry to PROP might contributc eo a profile [or segreption of those prodapoaod to gastric uloer from the "aotmaP populatloo but that this is probably not the case for duodenal ul0t:r candldatea. Subjocts without ulcer but who smoka at least one pack of cig.rettes per day were also tustad for PROP sensitivity. 'I7xae relatively heavy smokers showed a sigsti6earttly higiser proportion of insensitivc tasters in comparison to non-smokers. 'Ihus, this llmited approach to a eomplex problem does provide some e.jdcaoo of one constitutional differcnce com- moo to gastric uleer paticatt and to rclatively heavy cigarette smokers. To that extent, it teaCs to support the hypothesis under considcration. An obvious question is wrbetha lont-tesm smoking itself modifics taste sensitivity. A study o( young persoos, some o( whom arc just beginning to smoke, has been undertaken in an edfott to determine whether genetically- based tasu acuiry does indeed aet as a determinant of developing smoking practiccs. It has been shown alrcady that sensitivity to PROP is similar in both sexes up to the age of 16-20 yeus, but thcreaftcr decrcases in males at the rate of 0.052 threshold per year and in females at the rate of 0.026 threshold per year. In taammary, it can be stated that present evidence from Council studics fails to support the hypothais that cigarette smoiuna contributes to the genesis of peptic ulcer, and is better in accord with the oooocpt that genetic characteristia which predispose to uleer also tead to encourage smokint. It cannot be said that the matter is finally or eooclnstvely aettlod, Many gaps is knowledge have been indicated in the discussion nbove. Amonj the rseodod additianal studies are the following: 1. Epidemiologial studiw to explore any posaibb statistical eorrtta- tion between cigarette smoking and /nd6atos of peptic uka, with separate consideration of duodeaal uloer and gastric ulcer as aop- arate clinical and cilologjal entities. 2. Carefully controlled clinical studies of u3ctr healing under de~aCd regimens, with random divisioc into smot}o j utd n.n-smodtkS subgroups for comparison. 3. Better methods of de[inin6 and classifying attosa aod of meaaa- ing the reactiotu of subjocts to them. 4. Exploration of other psychological, biochemical or physioiogical characteristics of duodcaal and gastric uktr patients with a view to improving the reliability of differentiation between higiHusccpti- bks and low-susccptiblca. 5. Within a group of highly susceptible pasons, preferably without overt ulcer, obuuvation of the relative locidcoee of overt disease among randomly selo¢ted subgroups who smoke or refrain from smoking. 6. Psychological and psycho-pharmaeological studics to assess nico- tine or smoking as a"tranquilircr^ or reducer of saress effccis. The study of peptic ulcer deserves considerable attention in its own right, not so much as a major cause of mortality but as the source of much discomfort and suffering in our modern stressful society. Howcver, ulcer has been discnssod at some kngth in the present in- stance more particularly to illustrate the nature of the problems that are faced in the study of constitutional diseases and the kinds of approaches that The Council is making to their investigation. In fact, thae saax probkms and approacha have dominated The Council's more extensive iavutiga- iions of both lung cancer and the cardiovascular diseases. Before the subject is kft, it should be pointed out also that lung cancer patients show a much greater history o[ pcptic ulcer than the general popula- tion. This fact suggests the thought that whatever factors predispose to ulceY may prove to be related to those that also predispose to carcinoma of this site. 12 13
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~ Constitutional Facton in Cardiovascular Disease ?he general ooosidcratioaa that have been applied in approaching the study of peptic ukeF are equally valid Ln rolation to several of the leading cardiovascular diseases sacb as athan.ckrot+is„ hypertension and stroke. Numerous studies have bocn carried out regarding the efkcts of nico- tine or of smoking upon the pbysioiopcal or bioclxmical factors that are considered to havc troaoe possrditiop to the etiology of the ardiovas- cular diacasci Many ot tbesn were enumerated in The Council's 1963-64 Annual Report. So fsr ao dcu picture has cmcrgod of their ctioiogy, and the possible relations of tob.cco use to the suspected factors in ctlology are stiU less ekar. A rsst body ol irtfocmatlon on the acute pharmacology of nicotine IIas boaa buik up, both by Couacil studies and others, but concepts as to how sucb efieeis could caotribute e3troaically to genesis of ardiovas- cular diseases remain hijAly eonjoctural. A number of working hypotheses have, of oourse, been sat up and aro yader tat. Perhaps the studics most relevant to the question are those in which human or animal subjects have boca exposed chronically to nicotine or smoking for long periods. Rabbits or bcass kept on rather anificial types of atherogeaic dicts did not abow any convincing differcnces in the condition of their artaies u given niootine rcgularly with the diet. A human autopsy study, na sponsored by The Council, showed that any association cxisting between smoking practices and the developmeat of arteriosckrosis or kaioos resulting tbadrom is terwous and inconclusive. A similar autopsy study has beca sponsored over a loat period by The CouncU but raults arc not yet availsble. The well-known pcospocQve study of the Public Health Service in Framingham. Massaehwetts repoctod, among numerous other findings, that cigarette smokers have no grrsta iocidenoe of angina poctoris than non- smoicas. Since thia syndrome is regarded as most often being a chronic mani- fatation of coronary artay sclctosis, this IIndiag suggests that smoking does not cause or aecekrate such sckro.ia. StiA further, as evidence of the non-involvement of smoking in the chronic development o( aderotic diseases of the vascular system are the sutistical indications that cigar and pipe smokers have very nearly the same incidence ol theac diseases as non-smokcrs, even though they probably absorb as much nicotiac as dgarette staokers. At the present titne therefore, the weight of evidence is against the concept that either nicotine or sawkin=lmfiueacu the atherosclerotic process. The posubrlsty teataios, howsra, that smotina may contribute in some way to precipitation oi an astito epi.ode in persons who have a prsdisposing basic sclerotic cooditioo. Since the factors bringing about atvtt cardiac ischcmia or thrrknbosu are still quite ob.aun, several Council-sponsorod studies have bocn inaugurated with emphasis upon clotting atotDanisma s3ad the possible acute influcnecs o( smoking or nicotine upon t2><ao. . On the whoie, tlxsetoco, it may be said that while there is little evi- dcncc at present to support the fint hypotheais, wrbich attempts to relate cigarette smoking to causation of major cardiovascular disases, yet thia hypothesis cannot yet be considered as flaafty ruled out. Meanwhile investiaations suggested by tho second hypothesis have been undcrway. TDe Council has contributed for many years to a study of the precursors of hypatcnsion and coronary dboase, which aims at idcatj- lyin6 characteristics that may form the basis for prnAks capable of sep.nt- ing highly susceptible persons from those of trlathcly low susceptibility. Such factors may include gCaetk: physiological, mctabolic, p.ycbobtical and environmental ona. When human subjects aru dasajtsod by a siagk factor, the overlap between groups is so large that relative risks of dcvclop- ing discase cannot be catimatcd with any certainty for the individual. When, however, the difierrntiatioa is basod upon the presence or absence of several factors, the degree of differentlation b improved and overlap dimiaishod. Tbc people presently under study do not as yet sho.r any evidence of cardiovascular disease thelnsclves but have been divided into gsnups of presumably high, medium or low susceptibility on the basis of a number of factors with spccial emphasis on family hbrtory, sinee these diseases have been found to show familial trenQs which are considered to have a genetic basis. Discriminant function analysis has been useful in the investigation since it maximizca diftcrrncea bawoca populations. In one such study, nine var{- abla were used. The somatic variables used were height, weight, syaoiic pressure, diastolic prasure, pulse rate and serum cbolateroi level. Psycho- logical variables were scorr.a for depression, anxiety and anger. Subjects grouped accordina to the history of hypertension among their parents (both, fatha, motAa, ncitAer) atowrd significant mean differences in systolic pressure, diastolic pressure and serum cholesterol, but no signifi- cant differences in psyeholoaical factors. A similarly conducted study of persons in relation to parental coronary disease (father, mother, neither) sltoxcd mean significant differences in anxiety and depression, but none for any of the six somatic variables. When four groups of subjects were constructed on the basis of presence in their parents (ncither, fathcr, mother, both) of either hypertension or coronary disease or both, significant mean dif(crenccs bctwecn thcse groups were found with respoct to anxicty, systolic pressure and diastoiic pressure. Ca M 0 14 15
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' Nlcan dif[crcaccs in serum choiaterol and pulse rate only approached aptl5canoe• Cumulative frequency distributions o[ the function scora ol the four groups reveal in dct4il the clear sepnra4on ol three oi the four groups. The widcst separation lies botwroen Group I, with two neptive parents and Group IV, with two positive parents, with no crossing over; Group 11, the latha-positivc, motba-negativo group. takes an iatcrmediate position while Group 111, the fatha-ncptfre, taotht:r-posittva group showed littk diHcr- wcc from Group 1. The tatbjocta .roro all tnala and this finding suggcsts a sex dificrentx in the transmissioq a( cbarsdaiuia. A relation between ttaaicin=ptaetlooa of subjects and the cardiovascular disease histories of their pueats was shown previously by the utne invati- ptocs. This suggestod nat only that toatxitutlonal cbarsctcristia play a role in detamining smotini beharkr but tAat theso characiuistics may also be liakod to those that predispose tD dbeascs of thh kind. The investigaton have now aoatrarod the amoking practices of the same people in relation to the saax nine somatic and psychological variabla. The mw wae first divided into thtoe groups for compttrison: (1) non-smokers and occasional smokers, (2) heavy cigarette smokas and (3) intermediate smoitera (light and moderate cigarette smoitets plus combined smokers of aprettes and other forms of toDa.m). A highly significant diffcrtnce was found bawrow groups (1) and (2), a smalla significant one between (1) and (3), but no significant ditiercaca between (2) and (3). Latcr, a division was made into eight groups: (1) lifdon= nort-stwkcrs, (2) those who smokcd kss than once a day, (3) smokers of l to 10 cigarettes daily, (4) smokers ot 1 I to 19 eiyuetoes daily, (5) sutokers ol one pack or more daily, (6) pipe smotcrs, (7) smokers o( aII three forms of tob.oco, and (8) ex- smoi:as. There wCrn too few saioksas at cigars only or ot pipes plus cigars to lornn a group. Analysis of thcut eight pnottpt showod sigaificant diffcrcnccs. It appesrod that non-smokas, oecaaiooal sraokcrs and pipe smokers formod a ooastcJlatioft of siau7ar porsont, while fornter smokers and mixed smokers appearod to be quite a bit allte, bI1Ia= about half-way bctwocn noa-amokus and bcavy amokas. In both thrce-gottp and e3sht-gtoup campa,risons, the mean d'ucrim- inant function soore o( non-smokas wras at oae extreme and tbat of heavy cigarette snwtus at tha oder. In the tAroagoup comparisoa, pulsc rate and anxiety contributed anost fo the differuttiation. In the eight-group analysis, pulse rate eoutrtbatcd tho taost, with eboiateroi, diastolic pressure and anger contributing to a lcssa utsat. While it might be argued tLat such somatic factors as pulse ratc, diastolic pcstsure, or cboicsteroi level ani=ht themselves be altcrcd by recent or con- 16 tinucd smoking, it scems rather unlikely that anxiety or anger scores would 0 be affected by smoking, and such psychoiogical characteristics seem morc i` likcly to be a part of the congenital makeup whkb may influence tbe,kiads M of smoking behavior adopted. On the whole, it appears that rather substantial support has been adduced for the hypothesis that common or rdatod constitutional factors may influence both susceptibility to cardiovascular d3atases and also smok- ing behavior. Despite these studics, there is still no assurance that the best somatic or psychological factors for ditfcrcatiation have as yet been found. Those gM employed were selected somewhat arbitrarily on the basis o( sngacstirt: ~ studies by others, easc and reproducibility of measurements, etc. There is every reason to suppose that other llluminating ones can be found by coo- C.) tinuing investigations of this type, and the relative success heretofore at- tained should encourage intcnsificatioa of the search. Referenae has already bccn made to the opportunities that may lie in the use o( biochemical measurements. Cardiovascular Disease and Stress One Council-sponsored investigator has looked into relations between stressful occupation and incideneo of cardiovascalar diseases. Since stras cannot easily be measured by objective methods, an indirect method has beca used. Among lawyers, physicians, and other proLasional groupa, there are specialties that by common agccement aro particularly strasful whi)e othas arc relatively low in stress. Assuming that a/arge group within a high-saws speeialty must contain more persons subjocted to stress than a corresponding troup in a low-strcu spocialty within the wne poofcssion, coaaparisoos s.a+e . made of the rrclative incidcnce o( heart and artery diseases. A sianibcant difference was found. There was also a correlation with the aruount of ci=- aretto smoking. However, persons who stoppod smoking showed signifi- cantly lcss cardiovascular disease incidettco than those who had never smoked at a11. This finding is not in accord with tho conception that there could be a cumulative chronic effect o( smoking or o{ nicotine upon the cardiovascular system. It has been Intcrp:etad as indiatinj that voluntary •stoppets•• are a sclectcd group containing aa excess ol persons who can handle and resolve stress relatively easily. Such stndla are continuing. Oifier Cardiovascular Studies A long series of Council-assisted studies has culminated in devdop- mcnt of an improved method using rubidium 34 clearance for measuring 17 

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