Beyond Cholesterol-Part 2

A remarkable finding, that more heart attacks happen on Monday morning between 8:00 a.m. and 12 noon, than any other time of the week. Also, this finding is unique to humans, and is not found in any other animal. Scientists theorized that the occurrence of these heart attacks is not linked to bioryhythms, but is due to the psychological meaning of Monday morning, that happens to many people, after having 2 days off. Monday morning, unfortunately, means returning the a job of at best, minimal, if any satisfaction. And this recognition leads to the clustering of heart attacks. And made me wonder if fewer heart attacks might occur on Friday evening or during the weekend.

During my first year of practicing medicine, I ran into the granddaughter of one of my patients with coronary artery disease and other chronic illnesses. Her keen observation made me more willing to consider the significant role emotions play in disease states. When I inquired about her grandmother, she replied, “Grandma is fine. She only gets sick when she’s upset.” I was struck by her remarkable insight, as she was only 16 years old.

Dr. Susan Kobialka, Ph.D., a psychologist at the University of Chicago, studied AT&T executives during the corporation’s divestiture. At the time of the study, so many executives were having heart attacks that a coronary unit was placed in the corporate headquarters of Illinois Bell. Yet, in the midst of all this stress, other execs of similar age and ethnicity not only survived but thrived under the highly stressful conditions. They all displayed a commitment to their work, a sense of challenge in the face of difficult circumstances, and a perception that they were in control of their response to events, if not of the events themselves.

One of the most fascinating long-term studies I’ve discovered, which prompted me to reconsider my emphasis on diet and other physical risk factors, was conducted by Stewart Wolf, M.D., in Roseto, Pennsylvania. Early in the 1960s, this small town became well-known to the national medical community-the residents were experiencing a very low incidence of heart disease despite the fact that they smoked, ate, and drank alcohol, in typical American measure. The researchers sought to explain this unusual phenomena and concluded that the supportive, interactive, and close-knit nature of the town’s primarily Italian-American population created this “immunity” to heart disease.

Dr. Wolf believed that their rate of heart disease would increase in the 1970s, as this town composed of primarily of first-generation Italian American families, lost their traditional ways and became more “Americanized.” When they returned a decade later during the mid 1970s, the found that his prediction had come true. And twenty years after the initial visit, they returned in the 1980s, anticipating a lower level of heart disease, reflective of the national cholesterol reduction education initiative. Despite many of the resident’s efforts to lower their cholesterol levels, stop smoking and exercise more, their heart disease rate continued to increase. The researchers determined that their way of life, their focus on materialism and “conspicuous consumption” blocked the anticipated decline.

Another important study conducted at the University of California, San Franciso, involving residents of Alameda County, Calfornia for several years. Researchers evaluated them and found that social isolation is an important risk factor for all dieases, including heart disease. Scientists around the world have also determined there is an association between the absence of social support and heart disease in humans as well as animals.

Yugoslavian research found that physical risk factors such as smoking are altered by psychological factors that are in fact greater predictors of death.

Japan is a country filled with significant social support, and evidence that it contributes to the lower incidence of heart disease among its citizens and Japanese-Americans who maintain their cultural traditions. A 1993 study of heart attack patients found those with significantly lower levels of emotional support were almost three times more likely to die within ix months compared to those possessing much higher levels of support.

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