The Wicked Giants

Medical researchers have long disagreed bitterly over the cause of atherosclerosis (the most dangerous form of hardening of the arteries, which leads to heart attacks). Last week, thanks to some technically brilliant work at the University of California, the end of the disagreement seemed to be in sight.

In atherosclerosis, the inner walls of the arteries become clogged with fatty material. Part of this is cholesterol, a white, soapy-feeling substance (actually an alcohol) found in all animal fats, nerve tissues and egg yolk. Some doctors insisted that the cholesterol was the villain: there must be too much of it in the patient's blood. If it were cut out of the diet, the hardening of the arteries would at least be arrested.

Not so, said others with equal vehemence. The body makes cholesterol, they pointed out, even if it gets none in'food. And anyway, there is no evidence that cholesterol causes the fatty deposits; it merely accompanies them.

Guilt by Association. Both camps may be partly right, judging from a report given last week by the University of California's Dr. John W. Gofman to a meeting of doctors called by the New York Heart Association, Inc. There is strong evidence, said Dr. Gofman, that although many giant molecules circulating in the blood contain cholesterol, only certain special types seem to be associated with atherosclerosis. Definitely accused of "guilt by association" with atherosclerosis: giant molecules with a molecular weight of about 1,000,000, which contain 30% cholesterol, and have an ultracentrifuge flotation rate of 10 to 20.

Through the cooperation of dozens of doctors in the San Francisco Bay area, Dr. Gofman and his fellow workers have studied what they call "Sf 10-20 molecules" in the blood of 1,553 people. Most (900) were normal, but more than 600 suffered from heart, artery or kidney disease, high blood pressure or diabetes. Notable concentration of Sf 10-20 molecules were found in the blood of nearly all patients who had at some time had a heart attack (usually after a blood clot closes an artery supplying the heart muscle). This fact, said Dr. Gofman, was significant because 95% of such cases have atherosclerosis although it may never have been detected.

Response to Diet. The offending molecules occurred in every patient with an underactive thyroid, and in more than 90% of those with high blood pressure or coronary insufficiency. Perhaps even more significant for the future: more than half of the men and a third of the women with no known disease of the heart or arteries showed high levels of Sf 10-20 molecules. These people, Dr. Gofman suggested, may be those who, in time, will develop atherosclerosis.

Most hopeful was Dr. Gofman's report of the patients' response to a low-fat low-cholesterol diet.* After a few weeks there was a marked reduction in the concentration of abnormal molecules in their blood. The patients who had once had a heart attack showed just as much improvement as healthy men. But, Dr. Gofman emphasized, there was no evident connection between diet and the total amount of cholesterol of all kinds in the blood. Fortunately, the abnormal molecules, which seem to be involved in atherosclerosis are the ones that can be largely controlled by diet.

Scarcely less remarkable than the technical achievements of the California researchers is the career of the 31-year-old man who reported them. When Gofman got his Ph.D. in 1943 he was already the co-discoverer of uranium 233. one of the radioactive isotopes used in research which led to the atomic bomb. After leaving the Manhattan Project. Dr. Gofman went to medical school and in 1946 got his M.D. He is now an assistant professor of medical physics at Donner Laboratory in Berkeley, and senior member of the large team which has been probing the molecular make-up of the blood.

-Including lean meat, but excluding: meat fat animal lard, butter or whole milk; fatty fish such as salmon; egg yolk.

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