Lars Erik Böttiger

Serum triglycerides, to be or not to be a risk factor for ischaemic heart disease?

The Stockholm Prospective Study--in a 14.5 year follow-up of 3486 men--found plasma triglycerides but not plasma cholesterol to be an independent risk factor for ischaemic heart disease. This finding stands in sharp contrast to the opposite results of the 8.5 year follow-up of the Western Collaborative Group Study. Differences between the two studies are discussed as one way of explaining the varying results--the most important probably being the use of different end-points for the diagnosis of ischaemic heart disease, but geographical, environmental and ethnic differences may also be of importance.

Risk factors for death for males and females. A study of the death pattern in the Stockholm prospective study.

. In the Stockholm Prospective Study, 531 male and 163 female deaths had occurred during 14.5 years of observation. Deaths were divided into three categories: “ischemic”, “neoplastic” and “other” and their relations to entry characteristics were analyzed. For ischemic vascular deaths age, smoking, systolic blood pressure and triglycerides were independent risk factors for both sexes, while cholesterol and weight/height index were not. For neoplastic deaths age, smoking, systolic blood pressure and ESR were positively and cholesterol and weight/height index negatively associated. This negative association was found especially for colon carcinoma and not for, e.g., prostatic and bronchial carcinoma in men. For other deaths age, blood pressure and ESR were independent risk factors for men, and age, smoking and ESR for women.

Integrative biology (physiology) – a necessity!

It is now more than 25 years since C. P. Snow wrote his much quoted book, The Two Cultures. He had found that there appeared to be a chasm between the humanistic and the natural sciences. Later, I believe, much of these difficulties were overcome, but it seems that another chasm developed, this time within one of the natural sciences, namely medicine. In a much more recent book, New Prospects for Medicine [l], a number of outstanding medical scientists discuss the recent enormous advances of our knowledge, leading up to the present era of molecular medicine, molecular biology, etc., with special emphasis on the word ‘molecular’. Our studies and our knowledge during this century have step-by-step moved from organs to cells, into the cells and ‘further down’ into their most minute components. This has advanced our knowledge and brings hopes of solving problems up to now regarded as impossible, but it has in turn created new problems including that of an unfortunate tendency for imbalance in medical research. Many of the authors in New Prospects for Medicine also express concern at the increasingly greater distance between the frontiers of, on one hand, the new subcellular knowledge and, on the other hand, medicine as the art of medicine, or in Lewis Thomas’s words : ‘the whole enterprise of looking after sick people’ [ 2 ] . David Weatherall asks: ‘How are we going to train these supermen i.e. our new doctors i f we wish to continue to improve the quality of patient care and at the same time expect our future doctors to have a much more sophisticated understanding of disease at a molecular level?’ [3] His answer being: ‘We need a total reappraisal of the whole structure of academic medicine and medical education. ’ It seems to be a marked trend that most teachers of medicine, in the theoretical as well as in the clinical disciplines, teach their students what they