On the Trail of Heart Attacks in Seven Countries

By Henry Blackburn, MD

The Seven Countries Study was the first to examine systematically the relation among lifestyle, diet, and the rates of heart attack and stroke in contrasting populations. It has been one of the finer scientific adventures of our time and of the field of cardiovascular disease epidemiology. The idea of the study arose in various forms in the minds of imaginative individuals capable of integrating clinical, laboratory, and population evidence. Ancel Keys, the leader of the study, gave the concept its broad scope as well as its substance and direction.

This, my personal account of adventures in the field, conveys only a tiny part of the excitement, and recalls only a few of the many contributions and difficulties of the undertaking. Keys and I, and others, have addressed these issues elsewhere. Evaluation of the scientific and public health import of the Seven Countries Study is better left to others.

In the late ’50s, when this project was conceived and mounted, there was no “big science,” and nothing like a Program Project. So there was neither precedent nor support for a properly organized, rigorous, centrally directed, adequately funded, multi-center undertaking. But never mind. The Seven Countries Study was bold and forward-looking for its day, a pioneering effort. Its results, elucidating the lifestyles and mass phenomena that determine high and low population rates of heart attacks, have affected all our lives, and have powerfully influenced the public health.

These field experiences are presented with little balance among geographic settings, survey periods, or contributions made. In fact, no coordinator was present at all surveys in all areas, though Alessandro Menotti and I, between us, came close. This represents only a fragment of the adventure and is long on anecdote and short on concept, method, and results.

Admittedly, such a presentation says little for the long and fascinating history of science. On the other hand, many would find it interesting, I suspect, to read such personal accounts of the peregrinations, emotions, breakdowns, and triumphs of those engaged in some of the grander research projects, say, the Manhattan Project, or the Polio Vaccine Trials. Mainly for this reason, I persist.

The scientific literature today bears the fruits of Seven Countries Study researches. My purpose here is to provide the flavor — an account of the joys and tribulations of our field surveys in rural areas around the world. There traditions of subsistence living went on much as they had for centuries. I also try to depict the character of these lands and these peoples that the investigators have studied for more than thirty years. You are welcome to share our adventures in the field.

Henry Blackburn, MD
Minneapolis, MN, 1999