RelatedArticlesModule - Related
Two cardiac specialists reflect on New Zealanders’ heart health and treatments in the 60s and 70s. It wasn’t pretty.
Heart surgeon Alan Kerr used to hide his nicotine-stained fingers under his desk when advising patients to stop smoking. A packet-a-day man for nearly 20 years, he finally gave up in 1972 when he could no longer ignore the weight of evidence that smoking was a fast-track route to an early death from lung cancer or heart disease.
Cardiologist Ted Clarke, then a registrar in training, remembers presenting a heart attack patient’s case to a visiting American specialist around the same time. Not once did he mention the man’s cholesterol level – in those days, it wasn’t routinely measured. When he started as a cardiologist at Middlemore in 1974, no one over the age of 70 was admitted to intensive cardiac care, and few patients over the age of 65 were actively treated for high blood pressure. “Totally shocking,” he says.
Doctors were alarmed at the rising tide of heart patients. “We thought this was just the start – that it was an epidemic and it was all going to get worse, that people would start to have heart attacks at younger and younger ages…” They emphasised exercise, stopping smoking and controlling blood pressure, but as for diet, cholesterol and weight control, well, not so much.
There were a few vegetarian restaurants in Auckland that had sprung up in the 60s, says Clarke. “Of course, I never went into any of them in case I caught something…”
When he told a doctor friend in the States in 1974 that he was specialising in cardiology, the mate admonished him. “Why are you wasting time in cardiology? You can’t do anything apart from lowering blood pressure and doing cardiac bypass [operations]. And that was true, then.”
The past, as they say, is a foreign country; they do things differently there. In New Zealand 50 years ago, this meant people were dying of heart disease in their thousands – 7000 of us every year in a total population of 2.75 million, compared with about 5000 today in a population of 4.84 million.
Kerr started at Green Lane Hospital in 1961, when the bulk of heart surgery was for congenital defects in babies, and valve problems. The first coronary artery graft was done here by Sir Brian Barratt-Boyes in 1969, after which Kerr and later colleague Ken Graham took over the bulk of cases. By 1975, they were doing 300 to 400 a year, but demand escalated rapidly. By the 1980s, more than 200 people were on the waiting list; the worst year, 27 of them died. “It was out of control… a real nightmare,” says Kerr, who was performing up to 16 operations a week, and added a Saturday morning shift to try to keep up with the burgeoning caseload. The pressure continued until the 1990s, before an injection of cash, as well as the introduction of angiography and artery stenting, eased demand.
In the early days, says Kerr, there was a myth that Māori patients didn’t get coronary artery disease. “It was totally untrue. They got more. But they didn’t present to the hospital, because they didn’t go to their GPs with indigestion and angina symptoms. They died instead.”
With a strict age limit of 70 for access to fledgling coronary care units and heart surgery, it was rare for women to be intensively treated; because oestrogen is cardio-protective, they tend to develop heart disease later than men. But Kerr says in the 1960s and 70s, doctors were seeing predominantly men in their early 50s, and many in their 40s.
Despite being a former smoker, Kerr was a former distance runner, completing 34 marathons. His blood pressure now is what it was as a young doctor: the “ideal” 120/80. And Clarke, despite having a poor family history – his father died at 58 and his mother at 72, of heart attacks – is, at the age of 77, on no heart medication either, having ditched both statins and blood pressure medication, the later because of postural hypotension.
Clarke sees many older patients in his practice and spends more time reducing their medication than increasing it. “You take their blood pressure and it might be 110/70, and they’re presenting with fatigue, dizziness, impaired memory and breathlessness. It’s much more common than people think.
“As we age, we fail to break down medications as effectively and it’s surprising how much morbidity can come from treatment for hypertension. No one has bothered to change their doses or type of medicine.”