Dr. Lewis Kuller, pioneer of preventive cardiology, dies at 88

By RICHARD SANDOMIR

Dr. Lewis Kuller, a top epidemiologist and a leading figure in preventive cardiology, could trace his interest in the field to when he was a medical resident in Brooklyn in the early 1960s, responding by ambulance to emergency calls when people had died suddenly of heart attacks at home or in the street. Working out of Maimonides Hospital and routinely sent out on emergency calls, he noticed that most heart attack deaths happened outside the hospital.

“So we were going to the home and finding people dead, or in the street, but especially at home,” Dr. Kuller said in an interview for a University of Minnesota project on heart attack prevention in 2002, “and secondarily we would often go to the home and find people sticking their head out the window in acute pulmonary edema.”

The experience led him to a career of more than 60 years in which he studied the risk factors for cardiovascular disease through a breadth of clinical trials, much of that time as chairman of the epidemiology department at the University of Pittsburgh School of Public Health.

“Lew was at the leading edge of what we need to think about next,” Dr. Donald Lloyd-Jones, the immediate past president of the American Heart Association, said in a phone interview. “He really understood the humanity of public health.” Dr. Kuller died at 88 on Oct. 25 in a Pittsburgh hospital. His son, Steven, said the cause was pneumonia and congestive heart failure.

In the 1970s and ’80s, Dr. Kuller was the chief investigator in the 10-year Multiple Risk Factor Intervention Trial, colloquially known as “Mr. Fit.” Involving nearly 13,000 men between the ages of 35 and 57, it focused on reducing the risks of heart disease through aggressive intervention by treating blood pressure and high cholesterol and counselling cigarette smokers.

When researchers followed up with the men seven years later, those who had received special intervention had only a 7 percent lower rate of fatal heart disease than the men who had received medical care from their usual doctors. However, the combined fatal and non-fatal heart disease rate for those who received special intervention was significantly lower. Starting in the 1980s and continuing for nearly 25 years, Dr. Kuller was the architect of a trial called the Healthy Women Study, which demonstrated that menopause was a risk factor for cardiovascular disease. “He was one of the first to say that menopause is a very critical point in heart disease for women, that they seemed to be protected until that point,” Anne B. Newman, director of the Center for Aging and Population Health at the University of Pittsburgh School of Public Health, said in a phone interview.

Through ongoing studies in the 1980s and ’90s about the emergence of cardiovascular disease in people 65 and older and systolic hypertension among those over 60, Dr. Kuller helped develop two inexpensive, non-invasive tests to predict heart disease and strokes. Using the new methods, the study found that people with significant clogging of the arteries, or atherosclerosis — but without any outward symptoms of heart disease, like chest pains — were two or three times as likely to die within a few years as those without evidence of the condition.

“You don’t necessarily have to apply aggressive treatment to everyone with bad risk factors,” Dr. Kuller said.

Sandomir is a writer with NYT©2022

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