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tion and its affiliates are financing important studies in almost every aspect of these major problems.
Hardening of arteries.-Among the bright hopes for the future is the recently developed and widely held conviction that hardening of the arteries, responsible for well over half the deaths from heart and blood-vessel diseases each year, is neither inevitable nor irreversible. Hardening of the arteries is not necessarily associated with the process of aging, but rather it is now generally viewed as a disease of fat metabolism, representing a breakdown of the mechanism by which the body handles the fatty particles which are either developed within the body or which are taken into it in the food one eats. Intensive studies of these fatty particles, particularly cholesterol, and their relationship to hardening of the arteries, are now going forward in a number of laboratories throughout the country. Artery hardening is a forerunner of the heart attack and of the stroke.
Further studies were proceeding with anticoagulant therapy, and efforts were being made to find new and effective substances that check blood clots which form in narrow and diseased arteries.
Heart surgery.-Surgery on the heart has had a long history. It has become practical and relatively commonplace from the surgeon's viewpoint only during the last decade.
Spurred by recent surgical successes in repairing certain types of heart damage resulting from rheumatic fever and congenital deformities, scientists have been seeking ways of bypassing blood around the heart during surgery so that the surgeon can operate in full vision and in a dry field. One method for doing this, which has been attracting a great deal of attention, is the mechanical heart. During the past year, the first known case of a patient's survival through the use of an artificial heart machine was hailed as foreshadowing new possibilities for cardiac surgery. The development of this mechanical heart was a fine example of teamwork by scientists supported by the Michigan Heart Association, an affiliate of the American Heart Association, and engineers of the General Motors Corp. The substitute heart was used to detour the blood supply from the left ventricle of a 41-year-old man for almost an hour while his heart was opened by surgeons to repair a defective valve.
Progress also was reported during the past year in blood-vessel-grafting operations, bringing greater possibilities of relief to soldiers suffering battle injuries and other patients needing such surgical procedures.
High blood pressure.-Research has not yet found a way to prevent high blood pressure, another major condition responsible for damage to the heart and arteries. In many cases, however, thanks to research, we have learned methods for the control of elevated blood pressure through surgery, diet, and drugs. Ninety percent of high blood pressure is of the essential type of which the cause is unknown. Scientists have been devoting much attention to suspected factors, including nervous and glandular influences, personality traits, and heredity, all of which may affect the blood pressure. There is no dearth of drugs which theoretically will bring relief to the high-blood-pressure patient. One of the most important tasks facing investigators in this field today and for years to come is the evaluation of these drugs as to their long-range effectiveness, and the safety and practicality with which they may be administered. Scientists at work
In this section we present several more specific examples of the type of research activity which has been carried on by investigators who are supported by the Heart Association research program. These brief samplings will serve to bring out more sharply the necessity and worth of these projects, and the practical promise of immediate and future benefits which they offer to heart sufferers. Testing sex hormones.-In one research laboratory during the past year scientists were atempting to crack the mystery of why men are more susceptible to coronary heart disease than the so-called weaker sex. They had seized upon clues which seemed to show that the female sex hormone, estrogen, might be a factor protecting women from this disorder. It was found possible to arrest, and even reverse, the artery hardening process in chicks through the use of estrogen and other glandular products. In an effort to apply these findings to humans, other investigators were administering estrogen to male patients, and were attempting to determine whether this procedure would prevent a recurrence of coronary attacks.
Fighting shock.-Persons suffering severe heart attacks very often go into a state of serious collapse known as shock, in which the blood pressure falls 39087-53-pt. 1-8
precipitously. For some years investigators and clinicians have been trying various méans of combating this shock and restoring the blood pressure to normal as rapidly as possible in the hope of reducing the number of deaths from heart attacks. Two American Heart Association investigators have administered a blood pressure raising drug to patients who had suffered heart attacks and the results have been sufficiently encouraging to persuade them to continue the study.
Cutting heart valves.-One of the heart operations now well established is the reopening of the constricted mitral valve which has become scarred and narrowed as a result of rheumatic heart disease. Rheumatic heart disease also may scar and narrow the aortic valve, situated at the beginning of the main artery that conducts blood from the heart to the vessels supplying the rest of the body. Correction of this condition presents a much more difficult surgical problem because of the high pressure of the blood pouring through the aortic valve. Investigators are working to perfect a reliable technique for this operation. Repairing heart holes.-Some persons are born with an abnormal hole in the wall separating the two auricles, or upper chambers of the heart. If this congenital defect is very large, it often leads to heart failure later on. One investigator has developed a hollow rubber cone-shaped well device which is inserted into an auricle and through which the surgeon can perform a deliberate, careful, and complete repair of this type of defect.
Seeking rheumatic clues.-In the rheumatic fever field, studies have been made on rabbits to learn more about a substance known as C-reactive protein, which may play a role in the development of the disease or which may give some sort of measure of rheumatic activity in the body. Investigators are also attempting to obtain a better understanding of the development of rheumatic damage to the heart so that they may in time be able to prevent or minimize such damage. Aiding diagnosis.-Much work has been done on various types of a device known as the ballistocardiograph, a tool of great promise for research and possibly for clinical use in diagnosis of heart patients. The machine produces tracings which complement the information provided by the electrocardiograph.
THE JOINT RESEARCH PROGRAM
The national research support program of the American Heart Association is a joint undertaking of the national office and affiliated State and local heart associations. Into the national research program the national office places at least half of its 25 percent share of the total funds raised in the annual heart fund campaigns. A substantial portion of the balance retained by affiliated heart associations and their chapters is devoted to the financing of additional scientific investigations in their respective areas as part of their separate local research programs.
The 4-year record of research awards in both the joint national program and the separate local research programs of the affiliates is shown in the table on page 111. These represent the formative years of the American Heart Association as a voluntary health agency during which only limited funds have been available. Since the association began its national research support program in 1949, progressively higher sums have been allotted, making a total of almost $42 million. The expectation is that much greater support will be given to cardiovascular research as the heart program advances. Encouraging talent
The American Heart Association's research policy aims at developing a favorable climate in which research can move forward freely and continuously toward its goals. It strives to attract into the cardiovascular field the first-rate minds of skilled, imaginative scientists of proven talent and creative ability, and it tries to make it possible for these outstanding scientists to carry on their work without restricting pressures and without becoming too heavily burdened with teaching and administrative responsibilities.
The research ideal of the association is best demonstrated by the career investigatorship, created in 1951 as the first research position of its kind established in the voluntary health field for the encouragement of unrestricted, lifetime medical research. The career investigator receives an annual grant from the association throughout his productive career.
The first recipient of this new type of award, Dr. Victor Lorber, has transferred his research activities from Western Reserve University Medical School to the
University of Minnesota. Dr. Lorber is engaged in a study of chemical processes within the heart muscle. As funds permit, it is planned to create additional career investigatorships in the cardiovascular field.
Other research categories
Established investigatorships are awarded annually for a 5-year period to scientists of proven ability and superiority who are interested in a research
Research fellowships are granted for renewable 1-year periods to persons interested in research who plan to follow an academic career. They conduct their studies under seasoned scientific leadership.
Grants-in-aid are made to experienced investigators working in nonprofit institutions, medical schools, hospitals, and laboratories who have demonstrated their productiveness or who otherwise give promise of accumulating useful new information.
(A complete list and descriptions of association-supported research activities for the 1951-52 fiscal year may be obtained upon request from the medical director.)
4-year record of research awards by the American Heart Association and its
2 This amount includes the career investigator's salary and funds for technical assistance, supplies, and institutional overhead.
NOTE. Allocations for research in the national support program are made on a fiscal year basis. Funds allocated during a fiscal year come from the previous year's heart fund campaign, and are devoted to studies that are to be conducted during the fiscal year following the date of allocation.
AIDS TO THE MEDICAL PROFESSION
Medical research must be put to the use for which it is intended-helping human beings. To accomplish this, it is necessary to narrow the gap that often exists between an important scientific discovery and its actual application to save a life, to prevent or relieve suffering, to avert or lessen disability and waste.
Communications between the research scientist and the clinical physician who deals with sick people are being speeded up by the American Heart Association through the development of broad professional education programs. These programs provide practical information and tools to physicians and closely allied professional people, such as nurses, to help them deal more effectively with patients.
The annual scientific sessions and special activities of the various sections and councils of the scientific council are increasingly useful in bringing practical information to the medical profession. The national office produces and makes available a wide range of technical pamphlets, scientific journals and bulletins, manuals and guides, exhibits, teaching aids, films, pamphlets, and cardiac record forms. Among affiliated heart associations, the national office encourages the development of similar aids as well as conferences, seminars, institutes, postgraduate medical courses, nurses' institutes, and teaching courses in cardiovascular clinics, often arranged with the cooperation of local medical societies. The clinic program
The cardiovascular clinic offers an opportunity for putting into practice the latest scientific knowledge through its diagnostic and treatment services. The clinic also plays an important role in rendering consultation services for physicians and in providing unique opportunities for professional education and research not only for physicians, but also for nurses, social workers, and other professional personnel. The American Heart Association has been working to maintain high standards of service to heart patients through its national committee on cardiovascular clinics, which includes representatives of clinics committees of affiliated heart associations throughout the country.
On the basis of experience with the clinic program during the past several years, it has been decided by the board of directors to discontinue the certification of clinics by the national organization, reserving this action for affiliated associations which are better able to observe conditions and to evaluate clinics in their own areas.
The national committee will continue to set general policies, advise the affiliates on matters of clinic certification, and maintain a national file of information to assist affiliates in establishing new clinics and maintaining standards. The association's guidebook, Recommended Standards and Minimum Requirements for a Cardiovascular Clinic, is being revised to conform with the new policies, allowing for the assumption of local responsibility in clinic development. Scientific clearinghouse
The advance in the date of the 1952 scientific sessions proved highly successful, judging from the attendance and interest shown. For the first time the sessions, held in Cleveland in April, preceded the annual meeting of the American College of Physicians instead of the June meeting of the American Medical Association, as in previous years. Thirteen hundred physicians and scientists, representing a wide variety of disciplines, attended the sessions. Fifty-eight papers covered the latest experiences with new drugs, surgical procedures, diagnostic aids to the physician, and many other aspects of investigation supported by various sources in addition to the American Heart Association.
Heart interest at AMA
Although the scientific sessions were disassociated from the June meeting of the American Medical Association, the American Heart Association sponsored several features at the AMA event in Chicago which kept interest in cardiovascular matters at a high pitch. With the Illinois and Chicago Heart Associations, the American Heart Association cosponsored an exhibit booth and questionand-answer conferences. These were very well attended and won a special commendation from the AMA's committee on awards.
New research journal
Because of the expanding interest in basic research and the limited space available in existing publications for reports in this area, the need was felt for a separate publication devoted exclusively to fundamental studies. Responding to this need, the association initiated a new bimonthly journal, Circulation Research, as a companion publication to its monthly journal, Circulation. This was conceived as the first publication of its kind devoted exclusively to reports of basic research related to the heart and circulation. Dr. Carl J. Wiggers, director of the department of physiology, Western Reserve University School of Medicine, was named editor of the new journal, which began publication with the January 1953 issue.
"Circulation" adds features
Circulation, now in its fourth year of publication, continues as a monthly scientific journal devoting its contents more fully to clinical problems and applied research of more immediate interest to the physician in caring for his patients.
The clinical progress section, inaugurated in 1951, and clinical conferences, a bimonthly feature added last year, have increased the usefulness of this publication to the practicing physician.
"Heart Bulletin" for GP's
Heart associations have cooperated in helping to distribute the Heart Bulletin, a bimonthly magazine which began publication in March 1952 as a new medium for reporting the latest advances in diagnosis and treatment to the physician in general practice.
Teaching films needed
Development of the association's audiovisual program for medical as well as general education remained a serious problem because of high production costs, but it was hoped that up-to-date medical teaching films in the cardiovascular field as well as other needed new materials could be provided in the near future as funds become available. Meanwhile, the association's film library filled many requests from medical and nursing schools out of its limited supply of films and slides.
Rubber heart models
A popular visual aid in medical teaching developed and sold by the American Heart Association and its affiliates during the past year was a series of 10 new latex-rubber models of normal and abnormal hearts. These were particularly useful to medical schools and research institutes as well as to physicians in demonstrating heart conditions to patients and lay groups.
Setting cardiology standards
The association plays an important role in setting and maintaining standards of professional competence in cardiology. A committee of the scientific council, known as the Subspecialty Board on Cardiovascular Disease, provides the personnel and establishes standards for the examination of internists in the subspecialty of cardiology. The board conducts the examinations and reports its grades to the American Board of Internal Medicine.
During the past year, the subspecialty board also reviewed applications for approval of cardiovascular residency training in five institutions. The board offered recommendations on approval of these institutions to the Conference Committee on Graduate Training in Medicine of the American Medical Association's Council on Medical Education, which submitted the applications. Registry of pathology
No account of the association's efforts to advance professional education and research would be complete without mention of its support of the Registry of Cardiovascular Pathology, which is connected with the Armed Forces Institute of Pathology. The Registry receives gifts of interesting records and pathological specimens in the cardiovascular field. It provides consultation service and has planned to provide teaching material for loan to students and physicians. International meetings
Many association members attended the various cardiological meetings in Europe, Latin America, and other parts of the world in the fall of 1952. At the largest of these, the Fourth Inter-American Cardiological Congress in Buenos Aires in September, the association was represented by an official delegation of eight members, headed by Dr. Irving S. Wright, president. The association contributed toward the support of the Inter-American and the International Cardiological Societies.
EMPLOYMENT AND HEART DISEASE
Since economic pressures are so strong and so immediate in most cases of these chronic diseases, it is only natural that primary and increasing emphasis is being placed in program-building efforts on the need to keep the heart patient in his job, or to help him adjust to a different job more suited to his capacities. This is an extremely complex problem. It involves the national defense program, business and industry, labor organizations, the farm, and the family, and requires a great deal of educational activity among the various groups concerned. Until now, the work capacities of heart patients have not been adequately utilized, mainly through ignorance of what they can do, and because of the too widely held belief that a heart ailment condemns a patient to a life of invalid