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Atherosclerosis: Mechanisms as a guide to prevention
Book
reviews
HUMAN AGING, A BIOLOGICAL AND BEHAVIORAL STUDY. Edited by James E. Birren, Robert N. Butler, Samuel W. Greenhouse, Louis Sokoloff, and Marian R. Yarrow. Public Health Service Publication No. 986, Washington, D.C., 1963, IJnited States Government Printing Office, 328 pages. Price $3. This book represents the efforts of 22 contributors who present their data and ideas concerning various aspects of human aging. The book is published under the auspices of the National Institute of Mental Health of the National Institutes of Health. Many aspects of aging are discussed, including methods of study of aging of men, influence of aging on the cerebral circulation and metabolism, the electroencephalogram, psychomotor responses, auditory responses, mental testing, personality characteristics, and other aging phenomena. Obviously, a book of only 328 pages on such an expansive problem cannot be expected to be complete. Nevertheless, the chapters are interesting and the book is a good one.
ATHEROSCLEROSIS: MECHANISMS AS A GUIDE TO PREVENTION. By Campbell Moses, M.D., Associate Professor of Medicine, and Director, Addison H. Gibson Laboratory, University of Pittsburgh School of Medicine, Philadelphia, Pa. Philadelphia, 1963, Lea & Febiger, 239 pages, 54 illustrations. Price $8. The
subtitle of this book is “Mechanisms as a Guide to Prevention.” The author’s objective is “to provide for physicians with an interest in the problems of atherosclerosis a survey of present concepts of the mechanisms involved in its pathogenesis and, thereby, enable them to have a better understanding of present methods aimed at the prevention of atherosclerosis and its disastrous complications.” After a short chapter on the world-wide distribution of atherosclerosis, the first half of the book summarizes current knowledge and hypotheses about the biology of the process. In the longest chapter, on pathogenesis, the author distinguishes between local factors (the lipoproteins, collagen, elastin, fibrin, and the fibrinolysins) and modifying factors (genetic, hormonal, stress, diet), both sets acting over a relatively long period of time. Although control of the lipoproteins is a prominent feature of current therapies, the author suggests that changes in the collagen content and the elastic properties of the arteries may be the basic mechanism. Subsequent chapters in this section deal with the distribution and severity of lesions in the principal arteries, the roles of cholesterol metabolism and the lipoproteins, the biosynthesis of steroid hormones from cholesterol, and hormonal factors that affect lipid metabolism. Thereafter the author moves on to consider the detection and prevention or ameliorative treat-
140
mcnt of susceptible individuals. The relationships between atherosclerotic catastrophes and serum lipoproteins, body build, blood pressure, obesity, heredity, smoking, exercise, and emotional stress are reviewed in turn. The two final chapters discuss the principal hypocholesterolemic drugs and the question of dietary regimens. For the physician whose primary interest is in what the book has to say about prevention and treatment, short sutnmary statements appear at the end of most of the chapters in the second half. As might be expected in a book designed to give a balanced view of the subject, including its complexities, these recommendations are presented iu rather general and conservative terms. For example (p. 185) “exercise (at least in accustomed amounts) is probably good and certainly not deleterious. It probably never should be severe and unusual. Under no circumstances should severe and unusual esercise follow a deliciously fatty, generous meal.” One recommendation (p. 147) is that serum lipid levels be determined routinely in the late teens or early twenties and at subsequent annual health examinations, especially if there is a family history of cardiovascular trouble, diabetes, obesity, or hypertension. Needless to say, the book covers a wide range in a confusing field about which a great deal remains to be learned. The quality of the reviewing is excellent. The exposition is consistently clear. In areas of conflict the author’s summary comments are forthright and judicious (although, of course, some protagonists may dissent). Documentation by references is thorough. Moreover, the author includes accounts of research and hypotheses which currently are not thought likely to provide leads to better understanding of the process, but which might do so at some future time.
CONGENITAL ISOLATED VENTKICULAK SEPTAL DKFECT. HEMODYNAMICS, CLINICAL FEATURES ASP PROGNOSIS AFTER THE AGE OF Two YEARS. By Erik Sand$e, M.D., Copenhagen, 1963, Munksgaard, 218 pages. In this monograph, the author preseuts data ob tained from 87 patients with ventricular septal defect who were studied by right heart catheterization from 1947 through 1960. The patients were all over 2 years of age and had medium to large defects. In each study the diagnosis was established by the oxygen step-up methods. The monograph is divided into several se<‘tions. In the first section there is a review of the history of ventricular septal defect, and an extensive mathematical exegesis of the hemodynamic terms employed by the author. A second section deals with the correlations of hemodynamic, electrocardiographic, phonocardiographic, roentgenographic, and pathologic data. The cor-
reviews
HUMAN AGING, A BIOLOGICAL AND BEHAVIORAL STUDY. Edited by James E. Birren, Robert N. Butler, Samuel W. Greenhouse, Louis Sokoloff, and Marian R. Yarrow. Public Health Service Publication No. 986, Washington, D.C., 1963, IJnited States Government Printing Office, 328 pages. Price $3. This book represents the efforts of 22 contributors who present their data and ideas concerning various aspects of human aging. The book is published under the auspices of the National Institute of Mental Health of the National Institutes of Health. Many aspects of aging are discussed, including methods of study of aging of men, influence of aging on the cerebral circulation and metabolism, the electroencephalogram, psychomotor responses, auditory responses, mental testing, personality characteristics, and other aging phenomena. Obviously, a book of only 328 pages on such an expansive problem cannot be expected to be complete. Nevertheless, the chapters are interesting and the book is a good one.
ATHEROSCLEROSIS: MECHANISMS AS A GUIDE TO PREVENTION. By Campbell Moses, M.D., Associate Professor of Medicine, and Director, Addison H. Gibson Laboratory, University of Pittsburgh School of Medicine, Philadelphia, Pa. Philadelphia, 1963, Lea & Febiger, 239 pages, 54 illustrations. Price $8. The
subtitle of this book is “Mechanisms as a Guide to Prevention.” The author’s objective is “to provide for physicians with an interest in the problems of atherosclerosis a survey of present concepts of the mechanisms involved in its pathogenesis and, thereby, enable them to have a better understanding of present methods aimed at the prevention of atherosclerosis and its disastrous complications.” After a short chapter on the world-wide distribution of atherosclerosis, the first half of the book summarizes current knowledge and hypotheses about the biology of the process. In the longest chapter, on pathogenesis, the author distinguishes between local factors (the lipoproteins, collagen, elastin, fibrin, and the fibrinolysins) and modifying factors (genetic, hormonal, stress, diet), both sets acting over a relatively long period of time. Although control of the lipoproteins is a prominent feature of current therapies, the author suggests that changes in the collagen content and the elastic properties of the arteries may be the basic mechanism. Subsequent chapters in this section deal with the distribution and severity of lesions in the principal arteries, the roles of cholesterol metabolism and the lipoproteins, the biosynthesis of steroid hormones from cholesterol, and hormonal factors that affect lipid metabolism. Thereafter the author moves on to consider the detection and prevention or ameliorative treat-
140
mcnt of susceptible individuals. The relationships between atherosclerotic catastrophes and serum lipoproteins, body build, blood pressure, obesity, heredity, smoking, exercise, and emotional stress are reviewed in turn. The two final chapters discuss the principal hypocholesterolemic drugs and the question of dietary regimens. For the physician whose primary interest is in what the book has to say about prevention and treatment, short sutnmary statements appear at the end of most of the chapters in the second half. As might be expected in a book designed to give a balanced view of the subject, including its complexities, these recommendations are presented iu rather general and conservative terms. For example (p. 185) “exercise (at least in accustomed amounts) is probably good and certainly not deleterious. It probably never should be severe and unusual. Under no circumstances should severe and unusual esercise follow a deliciously fatty, generous meal.” One recommendation (p. 147) is that serum lipid levels be determined routinely in the late teens or early twenties and at subsequent annual health examinations, especially if there is a family history of cardiovascular trouble, diabetes, obesity, or hypertension. Needless to say, the book covers a wide range in a confusing field about which a great deal remains to be learned. The quality of the reviewing is excellent. The exposition is consistently clear. In areas of conflict the author’s summary comments are forthright and judicious (although, of course, some protagonists may dissent). Documentation by references is thorough. Moreover, the author includes accounts of research and hypotheses which currently are not thought likely to provide leads to better understanding of the process, but which might do so at some future time.
CONGENITAL ISOLATED VENTKICULAK SEPTAL DKFECT. HEMODYNAMICS, CLINICAL FEATURES ASP PROGNOSIS AFTER THE AGE OF Two YEARS. By Erik Sand$e, M.D., Copenhagen, 1963, Munksgaard, 218 pages. In this monograph, the author preseuts data ob tained from 87 patients with ventricular septal defect who were studied by right heart catheterization from 1947 through 1960. The patients were all over 2 years of age and had medium to large defects. In each study the diagnosis was established by the oxygen step-up methods. The monograph is divided into several se<‘tions. In the first section there is a review of the history of ventricular septal defect, and an extensive mathematical exegesis of the hemodynamic terms employed by the author. A second section deals with the correlations of hemodynamic, electrocardiographic, phonocardiographic, roentgenographic, and pathologic data. The cor-