A Change Of Heart: How The Framingham Heart Study Helped Unravel The Mysteries Of Cardiovascular Disease - Rilegato

Dr. Levy is a cardiologist who specializes in heart disease prevention and is Professor of Medicine at Boston University School of Medicine and on the faculty of Harvard Medical School. He presently serves as the Director of the Framingham Heart Study.

Susan Brink is a senior writer for U.S. News & World Report.

ONE
A Killer of Paupers and Presidents

It was April 12, 1945, and the country was heartbroken. Franklin D. Roosevelt, the thirty-second president of the United States, died suddenly in what had come to be known as the Little White House, a cottage in the woods of Pine Mountain near Warm Springs, Georgia. The public was unprepared for his death, though for many months his doctors knew that he was gravely ill. In keeping with the culture of the times, his personal physicians hid the grim reality of the president’s failing health from the press, from the public, from his family—even from FDR himself. Casualty of an as yet unrecognized epidemic, the leader of the free world slipped away.

Roosevelt, his doctors, and the media had colluded to portray him as the picture of health. Long before he was elected president, in the summer of 1921 when he was thirty-nine years old, he fell victim to another epidemic. Polio rendered his legs nearly useless, his ability to walk nothing more than a simulation. He supported dead weight from the waist down with braces locked at the knee, and he would swing himself forward in a practiced rhythm between crutches. Throughout his life, the public saw him as strong, self-assured, and independent. No American was privy to the scene of Arthur Prettyman, FDR’s personal valet, strapping full-leg braces on the president as he lay supine in bed. The metal of each brace was painted black, and the president always wore black shoes and socks so as not to draw undue attention to the contraption. It was, like the title of Hugh Gregory Gallagher’s book, FDR’s Splendid Deception.1 His walk was seldom photographed, nor was the wheelchair on which he often depended. When a rare photographer violated the White House rule, Secret Service agents would seize the film and expose it. Only pictures of Roosevelt in a strong, erect stance or a comfortably seated position were permitted.

Rumors that Roosevelt was in poor health circulated during his first run for president and were blamed on the opposition’s attempt to derail his candidacy. The country was in the throes of the Great Depression. America was mired in despair, and Roosevelt needed to prove that he was strong and steady. To still the gossip, he released his medical records in 1931. His blood pressure was 140/100—the 140 systolic only marginally hypertensive, but the 100 diastolic a bad omen. Even the most brilliant medical minds of the time possessed neither the knowledge to recognize the gravity of his disease nor the tools to treat it. The numbers did not raise questions, but periodic reports continued to emerge that he was ill. So in 1932 he took out a life insurance policy for $50,000, reassuring his supporters by passing the medical examination at the age of fifty.Shortly after assuming the presidency in 1933, in what may have been a fateful decision, Roosevelt selected Admiral Ross McIntire as his personal physician. Dr. McIntire was an ear, nose, and throat specialist whose main concern would be the president’s numerous head colds and sinus problems.

Roosevelt took the helm of a nation at a time that would have taxed the hardiest of souls. America was then home to between 13 million and 15 million unemployed workers. A couple of million of them took to the road to find employment. They created a whole class of homeless migrants. They left behind dust-ravaged farms and boarded-up factories to wander the country in search of work. Hundreds of thousands of them lived at the edge of cities in tents and shantytowns, dubbed “Hoovervilles” in disparaging reference to the president they blamed for their lot. Panic about the economy had forced the closing of banks in thirty-eight states. The plight of a stricken populace surely took its toll on their leader during his first term. “I see millions whose daily lives in city and on farm continue under conditions labeled indecent by a so-called polite society half a century ago. . . . I see one-third of a nation ill-housed, ill-clad, ill-nourished,” he said in his second inaugural speech.6 And, in words that live in memory and history, he tried to reassure Americans at his first inaugural when he said, “The only thing we have to fear is fear itself.”

As the strain registered in medically measurable form, McIntire hardly made note of the rise in the president’s blood pressure. It was 169/98 in 1937 as Roosevelt began his second term. From then on, it would fluctuate, but remain abnormally high. His vital numbers rose to 188/105 in 1941, when the Japanese bombed Pearl Harbor. Still, as is typical, he had no outward symptoms of hypertension. Roosevelt launched a nationwide war effort, committing more than 16 million U.S. troops to the Allied cause in World War II. By the time American soldiers landed in Normandy in June 1944, his blood pressure was 226/118—a life-threatening level. The limited medical technology of the day, electrocardiograms and chest X-rays, showed a damaged, enlarged heart. Still, no one told FDR the bad news, nor did he ask.

Roosevelt was absent from the White House for nine weeks during the first five months of 1944.9 In those days, he would go to Warm Springs, an impoverished farm community eighty miles southwest of Atlanta, Georgia, for an “off the record” absence from duties, which amounted to much-needed bed rest. He had gained sustenance and rejuvenation from the town’s healing waters since 1924. These trips were about his only concession to poor health, and the reason behind them went unspoken. In an era when the media grant no mercy in exposing the secrets of public officials, it is difficult to fathom that back then journalists would comply with and help promote such a public deception. Dr. McIntire insisted that the president’s health was good, that Roosevelt’s blood pressure was normal for a man his age. In his treatment notes of April 1944, when the president’s blood pressure was 210/120, McIntire wrote, “A moderate degree of arteriosclerosis, although no more than normal for a man of his age.”

Everyone, it seems, was happy to go along with the opinion, particularly since at the time there was nothing to be done for escalating blood pressure. There is hardly an American today who doesn’t know enough to shudder at the president’s vital numbers. Meanwhile, McIntire remained concerned chiefly about FDR’s upper respiratory system. He dosed the president daily with nose drops and sinus sprays. Containing vasoconstrictors, the drugs did little to relieve his breathing symptoms, and probably further increased his critically high blood pressure.

If the public was fooled into believing it had a healthy leader, his family was becoming alarmed at his failing appearance. His daughter Anna, who lived in the White House in 1944, became conscious

of the darkening hollows under his eyes, the loss of color in his face, the soft cough that accompanied him day and night. To her observant eye, his strength seemed to be failing him; he was abnormally tired even in the morning hours; he complained of frequent headaches and had trouble sleeping at night. Sitting beside him in the movies, she noticed for the first time that his mouth hung open for long periods; joining him at his cocktail hour, she saw the convulsive shake of his hand as he tried to light his cigarette; once, as he was signing his name to a letter, he blanked out halfway through, leaving a long illegible scrawl.

Careful listeners to his radio fireside chats might have noticed, certainly by 1944, an audible short-windedness that probably reflected some degree of congestive heart failure. But Eleanor Roosevelt, who had little patience for the distraction of illness, attributed her husband’s malaise to overwork and stress. When doctors began to urge a reduction of meat in his diet, the First Lady had prime cuts of steak delivered to the White House because her husband loved them. By early 1944, however, she was ready to reject McIntire’s diagnosis and ask for a second opinion. It was Anna who, at last, pushed McIntire into sending the president to Bethesda Naval Hospital in March for a thorough examination.

There, a young cardiologist, Dr. Howard Bruenn, pronounced the president desperately ill. But McIntire carefully controlled the disclosure of all medical information, and believed Bruenn’s view of FDR’s health would disturb the president and his family. In fact, he balked at Bruenn’s recommended treatments, which included bed rest, a light diet, salt reduction, and a program of weight loss.McIntire watered down Bruenn’s suggestions until the “regimen amounted to no more than treating a cold.” He was even more upbeat with the public. At a press conference following Roosevelt’s medical exam he declared, “I can say to you that the checkup is satisfactory. When we got through, we decided that for a man of 62, we had very little to argue about, with the exception that we have to combat the influenza plus the respiratory complications that came along afterward.”

Historians speculate that as Roosevelt’s cardiac problems became more apparent, McIntire grew more determined to hide the reality that he had overlooked or concealed for so long. It was a reaction that “one can only assume was a protection of his turf and a desire to hide the fact that he had failed to diagnose heart problems earlier.”Years later, in a 1970 journal article called “Clinical Notes on the Illness and Death of President Franklin D. Roosevelt,” Bruenn wrote about the frustration of treating FDR. His account of the examinations and treatments of the president was the first medical data made available apart from McIntire’s memoirs. Bruenn’s account contrasted sharply with the self- serving recollections of McIntire, and Bruenn concluded by saying, “I have often wondered what turn the subsequent course of history might have taken if the modern met...