dr. Lewis Kuller, Father of Preventive Cardiology, Dies at 88
dr. Lewis Kuller, a top epidemiologist and leader in preventive cardiology, could trace his interest in the field to his time as a resident in Brooklyn in the early 1960s, when he was responding by ambulance to emergency calls when people died suddenly of heart attacks at home or on the street.
Working out of the Maimonides Hospital and regularly dispatched to emergency calls, he noticed that most heart attack deaths occurred outside the hospital.
“So we’d go home and find people dead, or on the street, but especially at home,” Dr. Kuller said in an interview with the University of Minnesota Heart Attack Prevention Project in 2002, “and secondly, we’d often go to the home and find people sticking their heads out the window in acute pulmonary edema.”
That experience led him to a career of more than 60 years studying risk factors for cardiovascular disease through a series of clinical trials, much of that time as chairman of the epidemiology department at 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, past president of the American Heart Association, said in a telephone interview. “He really understood the humanity of public health.”
dr. Kuller died at the age of 88 on October 25 in a hospital in Pittsburgh. His son, Steven, said the cause was pneumonia and congestive heart failure.
In the 1970s and ’80s, Dr. Kuller was the principal investigator in the 10-year Multiple Risk Factor Trial, colloquially known as “Mr. Fit.” 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 counseling smokers.
When the researchers followed the men seven years later, those who received the special intervention had only a 7 percent lower rate of fatal heart disease than the men who received medical care from their usual doctors. However, the combined rate of fatal and nonfatal heart disease for those who received the special intervention was significantly lower.
Beginning in the 1980s and for nearly 25 years, Dr. Kuller was the architect of the trial called A study of healthy womenwhich showed that menopause is a risk factor for cardiovascular diseases.
“He was one of the first to say that menopause was a very critical point in heart disease for women, that they seemed to be protected up until that point,” Anne B. Newman, Director, Center on Aging and Population Health at the University of Pittsburgh School of Public Health, he said in a telephone interview.
Through ongoing studies in the 1980s and ’90s on the incidence of cardiovascular disease in people over age 65 and systolic hypertension among people over age 60, Dr. Kuller helped develop two inexpensive, noninvasive tests to predict heart disease and stroke.
Using new methods, the study found that people with significant artery clogging or atherosclerosis — but without any outward symptoms of heart disease, such as chest pain — were two to three times more likely to die within a few years than those without evidence of the condition.
“You don’t necessarily have to give aggressive treatment to everyone with bad risk factors,” dr. Kuller told The New York Times.
One test used high-frequency sound waves to assess possible blockages in the arteries that feed the brain; another measured differences between blood pressure in the arms and legs, with lower ratios indicating the likelihood of extensive atherosclerosis in the peripheral arteries of the legs. Both tests are still being conducted.
In the brain-directed test, an instrument called a duplex scanner aimed at the carotid arteries measures the speed of blood flow; a high velocity indicates that the artery is narrowing, because the blood entering the narrowed channel is accelerating.
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 in Clinton, NY, with a bachelor’s degree in 1955. He received his medical degree from George Washington University in 1959.
After an internship at Maimonides Hospital, he served as a medical officer in the Navy from 1961 to 1963, then studied at the Johns Hopkins University School of Hygiene and Public Health (now the Bloomberg School of Public Health), where he earned a master’s degree in public health in 1964. and Ph.D. 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. In those years, he published several studies on sudden cardiac death. In the journal Circulation in 1966, he and his colleagues reported the discovery that 32 percent of the deaths of Baltimore residents between 1964 and 1965 were sudden, and that arteriosclerotic heart disease was the cause of 58 percent of them.
In another study, published three years later in The American Journal of Cardiology, Dr. Kuller called for “a program of primary prevention of myocardial infarction and sudden death or methods of early diagnosis and treatment” to reduce heart disease.
Appointed chair of the Department of Epidemiology at the University of Pittsburgh in 1972, he was both a professor there and a frequent investigator in clinical trials, as well as the author of many journal articles.
“He had an inquisitive mind,” said Ross Prentice, a professor in the cancer prevention program at the Fred Hutchinson Cancer Center in Seattle, “and a willingness to study the literature, not only in areas where he might have worked, but he would send me things every a few weeks—’here’s what I found in this diary,’ he would say. He had great intellectual strength in his 80s.”
Among Dr. Kuller’s many studies was a small group of people who found a link between artery-clogging calcium deposits and the risk of dementia in people over 80 years old.
“If the delay or prevention of atherosclerosis resulted in a reduction or slowing of the progression of brain disease and the consequent onset of dementia,” said Dr. Kuller online publication of the University of Pittsburgh Medical Center in 2016, “then there is the potential for a very significant impact on reducing the majority of dementia in very old age.”
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, Dr. Kuller’s “Mr. Fit” study became célèbre after tobacco company RJ Reynolds said in an ad published in 25 newspapers and magazines that it 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 the evidence for the link is a long-standing scientific question.
In response to Reynolds’ ad, Dr. Kuller told The Post, “It’s like an ad that says, ‘Eat carcinogens — we need more time to think about this problem.'”