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JanuaC 24, 1983 t~ MEMORANDUM r TO: W. T. Hoyt CC: WDH .9 SCS FROMi: Leonard S. Zahn RFG RCH SUBJECT: American Heart Association Science Writers Forum Tucson, AZ, Jan. 9-12, 1983 The American Heart Association stages this media event an- nual'ly in order to condition the pulblic for National Heart Month, which is February. It's a rare year when the AHA staff and medical people on the planning committee omit a presentation relatinig to smoking, a topic they feel is always able to attract the attention of the writers who attend. There was no such omission at this year''s forum. In fact, there were two presentations on smoking, one scheduled for morningg newspapers of the following day, the other for afternoon editions. However, from all inidicationis_so far, the effort to create pub- licity seems to have failed for the most part. One of the presentations, by the chairman of the AHA Subcom- mittee on Smoking, JOHN A. OATES of Nashville, was such a trite rehash of old and tired material that one writer, who is strongly antitobacco, scoffed at it (at least to me). The other presenta- tion, by former CTR grantee MURRAY E. JARVIK, now of Los Angeles, alleged that smoking was a true addiction; it's possible there will eventually be somie coverage of what he said, but this prob- ably will be in paramedical or health-related journals. There were incidental mentions of-smoking by various sci- enitists during the meeting, but none was of'any real consequence. . .. .. . . . . .. . . .. . ~-. . .. -. ;~..Y.. G - ~ ._ .. . , The writers were attracted by talks that relalted hostility in Type A persons to an increased incidence of heart disease, and to sex and heart disease.-In regard to the latter, most of the stor- ies dealt with the wellknown fact that sex need not be feared by heart disease patients and canibe of benefit. And most of the writers ignored something reported' by one of the speakers: a study he did showed that a surprising number of heart attack patients had given up sex five or six years before suffering their attacks, but they claimed their marriages were stable and fairly happy. About 40 writers covered the session. Cities with newspapers represented included New York, Boston, Dallas, and Baltimore. Thee major newswire services, United Press International and!Associaite6 Press, were represented~as were the Chicago Tribune Service and Co Gannett News Service. Q wWC+' eonard ~~ ah74 FU9l~C RELAiIONS COUN.SEL~~ .. .. .. .. _-_.- . . . v, , andAssociates,hic (P. 0. BOX 223), 13 LINCOLN ROAD • GREAT NECK, N.Y. 11021 •1968}699 ;144F

w . 2. C It was learned'during the forum~, from a source considered to be reliable, that the Surgeon General's 1983 report will be is- sued in March. The heart association will prepare corollary mat- erial for aff4liates and chapters as soon as it gets the report. The highlights: 1. "Cigarette smoking and cardiovascular disease" -- OATES, professor of medicine and pharmacoliogy, at Vanderbilt University in Nashville, reviewed the evidence li~nking smoking to heart disease. The chief contributor to excess mortality in smokers is heart attack, he said. "The fundamental rationale for cigarette smoking,effects on the cardiovascular system is its association with atherosclerosis. While the exact mechanism by which smoking enhances atherogenesis is not fully understood, there is no reasonable doulbt to this con- clusion. Sufficient data have now been collected at the time of autopsy and fromiseveral rospective studies to show that the prev- alence and extent of atherosclerosis in the aorta and coronary arteries is significantly greater in smokers than that found among nonsmokers." He speculated that smoking is related to coronary disease because of nicotine's pharmacologic effect (increase in catechol- amines and heart rate), increased platelet coagulation leading to clotting and plaques, etc. There"s evidence that smoking of low tar-low nicotine cig- arettes reduces the risk of lung cancer, but findings from the Framingham Heart Study suggest that such cigarettes may even increase the risk of cardiovascular disease. Oates did say that smoking isn't associated with an increased prevalence of hypertension but added that two recent studies found a relationship between smoking and the development of severe (malignant) hypertension. Smoking was the most potent contributor to sudden cardiac death, according to data from two large prospective studies. Smok- ing is a major and independent risk factor in CHD and heart at- tack. Smokers are not only more likely to suffer a heart attack they are more likely to die from,it. The effect is related dir- ectly to dose, years of smoking and'inhalation. JAY COHN of Minneapolis, session moderator, said during dis- cussion that there's lots of sudden death in younger persons. Fil- ter-tip cigarettes don't reduce the risk of coronary mortality. Stroke is not strongly related•to smoking,. The chief effort should be aimed at prevention of smoking,, especially among children. O C.~ 2. "Cigarette smoking: a true addiction" -- JARVIK came on ~ w strong: smoking is the drug habit with the greatest impact on ,r, society. "Death and disease caused by alcohol and opiates are N -1

3- negligible compared with what cigarettes are'known to do." Nicotine provides much of the "positive reinforcement" from the use of tobacco, he said, but smokers will smoke niicotine-free cigarettes whtn nothing else is available, and' they do not par- ticularly like nicotinie withoult cigarettes. There must be another component of cigarettes different from nicotine which is at least "partially responsible for the pleasure derived from the hiabit." Quitting is an important problem in all addictions, espec- ially in smoking. Addiction to alcohol canicause some serious dis- orders, but moderate drinking seems to cause few harmful effects and may even be beneficial. However, there is no dose of cigarette smoking that is without deleterious effects. "Cigarette smoking produces and addiction or dependence stronger than any other drug including opiates and~alcohol." The occasional smoker, unliike the occasional drinker, is exceedingliy rare. Tobacco is a complex drug -- a "witch's brew" -- and nico- tine is probably the ingredient most responsible for the addic- tion. Tolerance to nicotine and other tobacco components does oc- cur. Though the illness following withdrawal is usually not debil- itating, the psychological craving can be intense and the tendency to relapse is high. "'Untili some method is found to disassociate the harmful ef- fects from the rewarding effects of smoking, it would behoove smokers to stop, and governments to discourage the production of cigarettes." During discussion, Jarvik said, half in jest, that the gov- ernment should make tobacco growing illegal, as is the case with poppies and marijuana, which "are much prettier and less harmful." The session moderator, DONALD HARRISON of Stanford, immediate past president of the heart association, disagreed with any pro- posal to prohibit smoking. It's far better to make smoking social- ly unacceptable, and that's the growing trend in this country. 3. There's considerable evidence that Type A persons -- and' that means half of us -- have more severe coronary artery disease (CAD) than non-Type A (Type B). But research reported at the ses- sion by REDFORD B. WILLIAMS of Duke University in Durham, N.C., has found the severity of CAD~to be even greater in Type As who score high in hostility as measured by a standard psychological O test (the Minnesota Multiphasic Personality Inventory, or MMP'I). CJ' w Williams said the general public as well as scientists and doctors regard Type A behavior to be equal in risk potential for ~ CHD to smoking, high cholesterol levels and high blood pressu~re. (X He and his colleagues recently completed a s~udy of 255 doc- tors who took the MMP'II in medical school 25 years ago. The rate of coronary disease in the ensuing period was less than 3% in half the doctors whose hostility scores were in the lower range for the

4. entire sample. However, in the hal'f'with high hostility scores, the rate was over 12°/'0, nearly a five-fold increase. Even "more striking," he said, was that higher hostility scores also1predicted mortality fromial!1 causes among the physi- cian sample. Inithose with hostility scores in the lower half, the 25-year mortality rate was only 3 %; however, it was 15% in the. half with higher hostility scores. Similar relationships also have been found~in a group of nearly 1,90'0 Chicago-area men who took the MMPI some 20 years ago and have been followed since. (This study, by Richard Shekel!le and others, and'the one described by Williams, will be published soon in "Psychosomatic Medicine.") It's not known how hostility and Type A behavior pattern are involved in the causation of coronary disease (and other diseases as well), but they may lead to increased levels of certain blood hormones. Laboratory studies have shown that stressed animals have higher levels of epinephrine, norepinephrine, cortisol, and tes- tosterone; these hormones have been implicated in fatty plaque formation in animal models of atherosclerosis. "It is quite plausible that the combined neuroendocrine re- sponse excesses we and others have observed in Type A individuals could be responsible for their increased risk of developing cor- onary heart disease," Williams said. He said that in the next decade or two it might be possible to id'entify with greater precision those individuals at risk for coronary disease. 4. In a talk on "Nerve growthifactor: do maternal antibodies cause birth defects?" EUGENE M. JOHNSON, Jr., St. Louis, said animal experiments done in his laboratory provide the "clearest demonstration that maternal antibody can be a teratogeni." Research results suggest the possibility that maternal antibodies which are transferred prenatally to the fetus could cause birth defects. - "It is noteworthy, however, that in the majority of birth defects the cause is completely unknown," he said. 5. Using coronary vascular smooth muscle obtained from hearts removed from transplant recipients, researchers at Stanford Uni- versity Medical Center, which has an active heart transplant program, have determined that histamine may be an important factor in coronary artery spasm. ROBERT GINS'BURG reported that histamine was infused intravenously into 1&patients with a history of chest pain. In several of the patients it was possible to show that the cause of the pain~was due to coronary spasm and that histamine (found abundantly in heart mast cells)' was useful as a "provoca- tive maneuver. " 03'734F19 Histamine is more than a passive bystander, Ginsburg said. It is an important vasoactive agent that is capable of regulating

5. coronary blood flow. Studies of'isolated hearts from transplant recipients havee shown that th.@ isolated coronary artery contracts and relaxes in an organized, rhythmic manner. This is the first time this ac- tivity has been observed in human coronary artery, Ginsburg said. 6. BARBARA HOWARD of Phoenix reported~ data from an ongoing study of Pima Indians in the American southwest. The Pimas have the highest recorded prevalence of diabetes mellitus and a highi prevalence of obesity, two major risk factors for cardiovascular disease (C'VD). However, their CVD rate is low: occurrence of acute heart attacks in P'ima:s between 1975-78' was 74/100,0100 person years compared to 378/100,000 person years among the general U.S. pop- ulation. There also is little evidence of atherosclerosis in the aortas and coronary arteries of Pimas examinediat autopsy. -END-

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