Tobacco Documents Online

C February 27, 1979 MEMORANDUM TO: W. T. Hoyt .9 FROM: Leonard S. Zahn CC: AY WUG RCH SUBJECT: American Heart Association's Sixth Science Writers Forum, Hilton Head Island, S.C., Jan. 14-17, 1979 The AHA's public information people did themselves proud this year in obtaining publicity via the familiar smoking-health route: three speakers on the subject got national press cover- age. That this happened only a few days after the Surgeon Gen- eral's report was issued pleased the AHA greatly. I don't believe there was a deliberate attempt to compete with the SG's report or to ride on its coat tail. The AHA al- ways has at least one speaker on smoking at the annual forum, but this year's session was, obviously, extra heavy in that area. The AHA officials at the forum suddenly realized the SG's report had been issued without comment from the AHA. They im- mediately prepared and released a statement applauding the re- port and stating that it reaffirmed the AHA's long-standing position. : The highlights:' 1. "Is cardiac anaphylaxis a cause of sudden death?" -- Roberto Levi, New York (Cornell University Medical College). The thrust of this talk was that a variety of substances may provoke acute reactions that could result in sudden cardiac death in some persons. The substances include environmental factors, dusts, animal danders, pollens, insect venoms, foods, various drugs, tobacco glycoprotein (TGPO, etc. The main factor-that follows intake of the allergen is the release of histamine in the heart, Levi said, and this is what leads to the severe anaphylactic reaction. Levi said he had sensitized guinea pigs -- whose sensi- tivity to histamine is similar to that of humans -- with a number of allergens, among them TGP obtained from Carl Becker of Cornell. Within two weeks, antibodies become fixed to the histamine-containing cells in various organs, including the heart. Then, when the animal or its excised surviving heart (most of his work is done with excised hearts) is challenged with the specific allergen, there is a "dramatic crisis" in cardiac function. He said he and his colleagues have estab- lished that histamine mediates the arrhythmias and contractile failure that characterize cardiac anaphylaxis. eonard ~ i_ M PUBLIC RELATIONS COUNSEL Ua+n~~drAOssociates,lnc. (P. O. BOX 223) 13 LINCOLN' ROAD • GREAT NECK, N,Y., 11021 •(212) 895-7445

2. While there are many allergens, tobacco is a major one, Levi said. Does smoking cause the release of histamine, he asked? There"is no exact proof yet, he said, but this is "likely and conceivable." He said suddent heart attacks kill about 350,000 Amer- icans yearly but that there is no way toestimate how many are actually the result of allergic reaction. Levi told me later in the meeting that Becker has just about obtained two purified antigens (presumably from tobacco leaves or smoke condensate) and will be publishing this fact soon. 2. "Detecting symptomless atherosclerosis" -- Valentin Fuster, Rochester, Minn. He is experimenting with pigs in search of support for this theory: Atherosclerotic lesions be- gin to develop in arteries as result of an injury, such as a tear in the artery lining, near bifurcations where blood tur- bulence is greatest. Blood platelets rushing to the point of injury to promote.clotting become a"trigger" for other events. The platelets promote the proliferation of smooth muscle cells and the growth of collagen. The collagen, together with fat particles and clot material, builds up on the artery wall, a plaque develops and eventually the artery is blocked. He is using von Willebrand pigs, animals which have an . inherited' disease: prolonged bleeding because of impaired platelets (von Willebrand's disease, discovered in humans about 55 years ago). He theorizes that the so-called von Wil- lebrand factor, a protein found in endothelial cells, may favor the platelet-arterial wall interaction that leads to atheroslcerosis. A clinical aspect of his work dealt with seeking to iden- tifying young (under age 50) heart disease patients prior to onset of symptoms. He said that smokers of at least on pack daily for 10 years and a strong family history of coronary disease in first degree relatives under age 50 were the two most significant risk factors. The presences of both in the same individual makes the likelihood of coronary"disease very high, Fuster added. He conducted platelet survival tests in 50 patients un- der age 50 who had coronary disease, in 28 apparently normal persons under age 50 without the risk factors, and in 21 ap- parently normal smokers under age 50. More than half the coronary disease patients and the ap- parently normal individuals who were smokers had abnormally y

3 increased platelet consumption when compared with the apparent- ly normal group without risk factors. The increase in the cor- onary disease patient is consistent with the role of plate- lets in the development and progression of atherosclerosis,. Fuster continued. The similar increase in the apparently nor- mal individuals who were smokers raises these questions: Is the apparently normal person who smokes and has an in- creased platelet consumption at a higher potential risk to de- velop heart disease? Or is he already developing disease that is not yet severe enough to manifest symptoms? While he had no exact answers, Fuster said that in the ma- jority of smokers with increased platelet consumption, dis- continuation of smoking for a month resulted in a return to- ward normal. Does smoking increase platelet activity that causes injury to the arterial wall, he asked? Or is it the nicotine or car- bon monoxide in the smoke that injures the artery? There's just not enough information to answer these, Fuster said, but animal work has shown that smoking appears to injure the ar- tery directly. He said he is planning an experiment in which pigs will be exposed to smoke. 3. "Cigarette smoking and the outcome of pregnancy" -- Richard'L. Naeye, Hershey, Pa. Naeye again ran through his lit- any of charges against smoking as the cause of a multitude of adverse effects in pregnancy. The result was considerable press attention, primarily because of stories carried by the news wire services. The data he described were from the U.S. Collaborative Perinatal Project which followed the course of 53,518 preg- nancies in 12 different hospitals in different regions between 1959-66 and~recorded information on gestation, labor, deliv- ery, and the neonatal period. There were more than 1,000 pieces of information on each pregnancy and the health and "psychomotor" development of the infants were followed until there were 8 years old. He said the results showed: 1. Smoking proved independent- ly to increase the frequency of premature separation of the placenta (65% increase), Rh disease (81% increase) and major -congenital malformations (43%). 2. There were shorter preg- nancies in smoking women than in nonsmoking women because of amniotic fluid bacterial infections that cause a series of events lead'ing to premature labor. 3. Smaller babies were born to smoking women because of microscopic lesions in the placentas of the smokers, indicating,a lower blood flow from the mother's circulation. 4. IQ values of offspring of smokers

4. C ,.;, . i' were virtually the same as those of children born to nonsmokers. (It took a question to elicit some details of this point which a wire service reporter used as the lead for his story.) 5. There was an increased frequency (52%) of sudden infant death syndrome in offspring of mothers who smoked during pregnancy. An effort was made to get information from Naeye about the drinking habits of the stu~dy population. It was pointed out that several major studies had cited the importance of the fe- tal alcohol syndrome, but Naeye said the data on drinking were not considered "Valuable" or pertinent. 4. "Cigarette smoking prevention and cessation programs" -- Alfred L. McAlister, Boston. Describing anti-smoking programs under way among upper middle class 7th graders in 10 schools -- six in the Boston area and four in the San Jose, Cal., area -- McAlister used catchy words about "inoculating" children against the "infection" of cigarette smoking. Such words made a natural lead for several newsmen. McAlister said the program includes seven learning sessions with:older children serving as peer models,, skits and role- playing. It is showing success in preventing kids from begin- ning to smoke and using marihuana and alcohol. The program is being conducted by Harvard and the Stan- ford~University Heart Disease Prevention Program~. The latter has the three-community stop-smoking program aimed at adults and this is going to be expanded, McAlister said. }. "The Framingham Heart Study's impact on preventive car- diology" -- William B. Kannel, Framingham~. In this review, Kan- nel stressed'that the Framingham study pioneered a new concept of epidemiology and produced a mass of information about risk factors that holds the key to prevention of heart disease. The effect of these risk factors has been ascertained, he said, and a cardiovascular disease (CVD) risk profile has been de- vised that helps identify the prime candidates for the disease long before symptoms arise. Kannel admitted that "some prom-' inentT" cardiologists questioned the CVD profile but that its concepts have now been firmly established and validated. He ran through the list of risk factors without stressing any single one. Kannel said the National Heart, Lung and Blood Institute ___-eq7prjars uninterested now in the original Framingham population (5,2 ::~ in cD C4-)- 1 ~ ~~ ~--~ F-- ;:~ N ~ rea t crW 9 men and women enrolled in 1948) and is interested only ~e ongoing study encompassing,offspring. Apparently NHLBI oviding support only for continuing surveillance of mor- y of the original population, not the re-examinations. e question now,, he said, is whether the original investi- can outlive the original population.