Dr. Lewis Kuller, a leading epidemiologist and leading figure in preventive cardiology, could trace his interest in the field to when he was a resident physician in Brooklyn in the early 1960s, responding to emergency calls by ambulance when people died suddenly. attacks at home or in the street.
Working at Maimonides Hospital and regularly dispatched on emergency calls, he noticed that most heart attack deaths occurred outside the hospital.
“So we would go home and find dead people, or on the streets, but mostly at home,” Dr. Kuller said in an interview for a University of Minnesota Heart Attack Prevention Project in 2002. , “and secondarily, we would often go home and find people sticking their heads out the window with acute pulmonary edema.
This experience led him to a career spanning more than 60 years during which he studied risk factors for cardiovascular disease through a multitude of clinical trials, most of the time as chairman of the department of epidemiology. from the University of Pittsburgh School of Public Health.
“Lew was at the forefront of what we need to think about next,” Dr. Donald Lloyd-Jones, the former president of the American Heart Association, said in a phone interview. “He really understood the humanity of public health.”
Dr. Kuller died at age 88 on October 25 at a Pittsburgh hospital. Her son, Steven, said the cause was pneumonia and congestive heart failure.
In the 1970s and 1980s, Dr. Kuller was the chief investigator of the 10-year multiple risk factor intervention trial, colloquially known as “Mr. Adapt.” 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 advising cigarette smokers .
When researchers followed the men seven years later, those who received special intervention had only a 7% lower rate of fatal heart disease than men who received medical care from their regular doctors. However, the combined rate of fatal and non-fatal heart disease for those who received special intervention was significantly lower.
Beginning in the 1980s and for nearly 25 years, Dr. Kuller was the architect of a trial called the Healthy Women Study, which found menopause to be a risk factor for cardiovascular disease.
“He was one of the first to say that menopause is a very critical point of heart disease in women, that they seemed to be protected until that point,” said Anne B. Newman, director of the University Center for Aging and Population Health. from the Pittsburgh School of Public Health, said in a phone interview.
With ongoing studies in the 1980s and 1990s on the emergence of cardiovascular disease in people 65 and older and systolic hypertension in people over 60, Dr. Kuller helped develop two tests inexpensive non-invasive drugs to predict heart disease and stroke.
Using the new methods, the study found that people with severe artery blockage or atherosclerosis – but without any outward symptoms of heart disease, such as chest pain – were two or three times more likely to die. in a few years than those without proof. of State.
“You don’t have to aggressively treat everyone with the wrong risk factors,” Dr. Kuller told The New York Times.
One test used high-frequency sound waves to assess potential blockages in the arteries that supply the brain; the other measured differences between blood pressure in the arms and legs, with lower ratios indicating the likelihood of extensive atherosclerosis in the arteries peripheral to the legs. Both tests are still performed.
In the brain-centric test, an instrument called a duplex scanner aimed at the carotid arteries measures blood flow velocity; a high velocity indicates that the artery has narrowed, as blood entering a narrowed channel accelerates.
Lewis Henry Kuller was born in Brooklyn on January 9, 1934. His father, Meyer, owned a pharmacy; his mother, Dora (Olener) Kuller, was a kindergarten teacher.
He graduated from Hamilton College, Clinton, NY with a bachelor’s degree in 1955. He received his medical degree from George Washington University in 1959.
After his residency at Maimonides Hospital, he served as a Navy medical officer from 1961 to 1963, then studied at the Johns Hopkins University School of Hygiene and Public Health (now the School Bloomberg Public Health), where he earned a master’s degree in public health in 1964 and a doctorate. in 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. During these years he published several studies on sudden cardiac death. In the journal Circulation in 1966, he and his colleagues reported finding that 32% of Baltimore deaths between 1964 and 1965 were sudden, and that arteriosclerotic heart disease accounted for 58% of them.
In another study, published three years later in The American Journal of Cardiology, Dr. Kuller called for a “primary prevention program for myocardial infarction and sudden death or methods of early diagnosis and treatment to reduce heart disease.
Appointed chairman of the Department of Epidemiology at the University of Pittsburgh in 1972, he was also a frequent professor and researcher in clinical trials there, as well as the author of numerous journal articles.
“He had an inquisitive mind,” said Ross Prentice, a professor in the cancer prevention program at Seattle’s Fred Hutchinson Cancer Center, “and a willingness to study literature, not just in areas where he might work, but he sent me things every two weeks—“here’s what I found in that newspaper,” he said.He had great intellectual vigor well into his 80s.
Among Dr. Kuller’s many studies was one of a small group of people who found a link between artery-clogging calcium deposits and a risk of dementia in people over 80.
“If delaying or preventing atherosclerosis led to reduction or slowing of brain disease progression and subsequent incidence of dementia,” Dr. University of Pittsburgh in 2016, “then there is potential for a very substantial impact in reducing the majority of dementias in the very old.
In addition to his son, Dr. Kuller is survived by his wife, Alice (Bisgaier) Kuller; his daughters, Gail Enda and Anne Kuller; and six grandchildren.
In 1985, “Mr. Fit” became a cause celebre when an advertisement 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 evidence for the link was a long-established scientific question.
In response to Reynolds’ ad, Dr. Kuller told the Post, “It’s like an ad that says, ‘Eat a carcinogen – we need more time to think about the problem.'”
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