August 24, 2011

USA: W. B. Kannel, Who Led Historic Heart Study, Dies at 87

NEW YORK, NY / The New York Times / Health / August 24, 2011

W. B. Kannel, Who Led Historic Heart Study, Dies at 87

By Margalit Fox

William B. Kannel, a cardiovascular epidemiologist whose work helped to identify and sought to rout the culprits behind heart attacks, strokes and other cardiovascular diseases, died on Saturday in Natick, Mass. He was 87.

William B. Kannel Suzanne Kreiter/The Boston Globe

The cause was cancer, his family said. At his death, Dr. Kannel was emeritus professor of medicine and public health at the Boston University School of Medicine.

Dr. Kannel (pronounced CAN-nell) was a former director of the Framingham Heart Study, the longest and most comprehensive study of the American heart ever undertaken.

Started in 1948, and continuing to this day, it followed an initial group of more than 5,000 Framingham, Mass., residents over many years. Its aim was to determine the causes of cardiovascular disease, which at midcentury was epidemic but poorly understood.

Begun by the United States Public Health Service, the study was transferred to the National Heart Institute, part of the National Institutes of Health, in 1949. Today, it is run collaboratively by Boston University and the National Heart, Lung, and Blood Institute, which succeeded the National Heart Institute.

Dr. Kannel joined the Framingham study in the early 1950s, serving as its director from 1966 to 1979. Afterward he was a principal investigator on the study and remained involved with it until nearly the end of his life.

Before the Framingham study, the words “cardiovascular,” “epidemiology” and “prevention” were unaccustomed bedfellows. Heart attacks and strokes were largely seen as tragic inevitabilities, thunderbolts that could rarely be predicted or prevented. Their scientific study was generally a post-hoc — often a post-mortem — affair.

The Framingham study asked two novel questions: For whom exactly was cardiovascular disease inevitable, and did it have to be quite as inevitable as it was? The study’s findings — which have informed more than 1,200 research papers — are credited with altering the way doctors and patients think about cardiovascular disease.

Among the social transformations attributed to the study is today’s heightened awareness of the importance of lifestyle changes like healthy eating, exercising and quitting smoking in reducing the risk of such disease.

From its inception, the Framingham study was unusual. For one thing, epidemiological studies had until then been the province of infectious-disease research. For another, where earlier clinical research had looked at patients who had already suffered heart attacks or strokes, this study admitted only healthy adults.

Subjects were given extensive medical exams every two years; should one of them have a heart attack or stroke later on, its underlying causes would already have been well documented.

“This type of study is a waiting game,” Dr. Kannel said in an oral history interview with PBS in 2006. “You make measurements of the characteristics of the people you’re following and then wait for them to get sick or not get sick.”

Over time, the Framingham study identified risk factors for cardiovascular disease including obesity, high blood pressure, smoking and lack of exercise. While these factors are common knowledge today, they were noteworthy at the time.

Smoking, for instance, had been known to cause pulmonary ailments like lung cancer and emphysema, but had not previously been implicated in cardiovascular problems.

What was more, the study established that cardiovascular disease most often resulted from a web of interdependencies — various risk factors acting in concert — rather than from one factor acting alone, as had commonly been believed.

Gathering and analyzing data on so many aspects of patients’ medical and social lives was no small trick in the study’s early days.

“We had something like 80 variables to apply to this task and no computers, no copy machines,” Dr. Kannel told PBS. “We were supposed to do this all by hand, using carbon paper and electric typewriters and an abacus for counting and doing statistical analysis. We had a primitive punch-card apparatus that did counting and sorting. The machine that did this was as big as an upright piano. It clanked away for eight hours to count and sort what a computer could now do in two seconds.”

William Bernard Kannel was born in Brooklyn on Dec. 13, 1923. He briefly studied chemical engineering at the City College of New York before his studies there were interrupted by Army service in World War II. He later did premedical study at the University of Florida and earned a degree from the Medical College of Georgia in 1949.

Dr. Kannel joined the United States Public Health Service that year, and remained with the organization until 1979. While working on the Framingham study, he attended the Harvard School of Public Health, receiving a master’s degree there in 1959.

He joined the Framingham study as a protégé of its first director, Thomas R. Dawber. In 1971, under Dr. Kannel’s stewardship, the study was expanded to include its second generation: the original subjects’ children and their spouses.

Dr. Kannel, who lived in South Natick, Mass., and Royal Palm Beach, Fla., is survived by his wife of 69 years, the former Rita Ruth Lefkowitz; two sons, Steven and Scot; two daughters, Linda Isaacson and Patricia Hoffman; 12 grandchildren; and 21 great-grandchildren.

He is also survived by the men and women of the Framingham Heart Study. Now in its third generation, the study follows more than 14,000 people, among them a few hardy, disease-defying members of the original group.

“I think our surviving cohort have been wonderful and deserve all the credit they can get,” Dr. Kannel told PBS in 2006. “It’s now a contest actually between the senior investigators and the cohort to see who will survive longer.”

He added, “I suspect they will.”

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