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In front of the White House, a heart at risk. VINCE MANNINO-UPI/CORBIS-BETTMANN

Death from coronary artery disease is dramatically less likely for Americans now than it was 50 years ago. The conventional wisdom accounting for the improvement is that we get cleverer surgical and medical treatment and employ preventive strategies, such as showing restraint with the butter knife, quitting smoking, and discovering and treating our hypertension. But a team of researchers coordinated by epidemiologist Dimitrios Trichopoulos, S.M.H. '68, Gregory professor of cancer prevention at the School of Public Health, advances the idea that better heating and air-conditioning--climate control--have helped us dodge coronaries.

In an ecological study of 30 million reported coronary deaths and their seasonal variation over 55 years, investigators at Harvard and Boston University discovered that the decline in coronary deaths closely corresponds to the increased use of heating in homes, workplaces, and vehicles in winter, and the air-conditioning thereof in summer. The study, which was published last fall in the Journal of the American Medical Association, tracked changes in the seasonal variation of coronary deaths in New England and the South from 1937 through 1991. More people die of heart attacks in the winter than in the summer. But winter became relatively less lethal during the period Trichopoulos and his colleagues studied. They found that the winter-to-summer ratio of coronary death declined by about 2 percent a year, a rate corresponding with improvement in heating. (The decline was steeper in New England.) The decline continued until 1970, by which time heating had improved generally. Thereafter, the winter-to-summer ratio began to increase. The change came in tandem with the rapidly growing use of air conditioning, which reduced death in summer (heat waves kill, too), thus increasing the relative proportion of winter deaths. Extremes of cold have been recognized as triggers for coronary events, although just how the trigger works is not adequately understood, says Trichopoulos. The new study, the authors believe, demonstrates what they would have predicted: that giving people more control of temperatures where they live and work would help prevent deaths from heart attacks.

The greatest killer of Americans remains the heart attack, but the population is not equally at risk. "Mortality from coronary heart disease is higher among low-income groups," write the authors of the study, "and housing and working conditions of the underprivileged are often substandard. If cold and very hot weather play an important role in coronary mortality, part of the socioeconomic differential in coronary mortality could be explained in terms of degree of control of microclimatic conditions." "Public officials must take that into consideration when they make decisions about the costs of subsidizing heating and cooling for the poor," says Trichopoulos. "Three things make one more at risk of having a heart attack--being poor, being a man, or being a smoker. Being poor is worse than smoking."

~ Christopher Reed

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