Hold the Eggs and Butter

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At the opposite extreme from the Melmans are people who seem to be genetically programmed to escape the problem. The Pima Indians of Arizona have the world's highest known rate of diabetes and one of the highest rates of obesity, both of which should increase their risk of heart disease. To make matters worse, they subsist on a diet heavy in foods fried in lard. Despite all this, Pimas have moderately low levels of LDL and only about one-fourth the heart-attack rate of the American public. Scientists believe that what makes the Pimas different from the more vulnerable masses is not that their bodies produce less cholesterol, but rather that they are more efficient at removing it from the bloodstream. Says Barbara Howard, a researcher for the National Institutes of Health: "The Pimas may have more LDL receptors or else more efficient ones than most people."

The same may be true for the 1% to 2% of Americans who, according to Rockefeller University Geneticist Jan Breslow, "have a genetic composition that makes them immune to atherosclerosis." Breslow calls this advantage "the Winston Churchill factor." Says he: "These people break all the rules; they eat eggs, bacon and meat, and they smoke. And they live to be 95."

For the 98% of Americans who are neither Winston Churchills nor Pimas, playing by the rules is important. It is a rare doctor, however, who will recommend dietary reform to a patient unless his cholesterol level is already quite high or he has suffered a heart attack. "Most physicians are used to treating acute illnesses; they are less comfortable with preventive medicine for healthy-looking patients," says Dr. Eugene Passamani, associate director for cardiology at the National Institutes of Health. As a result, individuals must usually make up their own minds about a change in diet. The trends of the past two decades give cause for optimism. Medical researchers generally believe that Americans will become increasingly willing to change to a healthier diet and a more sensible lifestyle. By the year 2000, they say, heart disease could cease to be the leading cause of death in America. Twenty years ago, says Dr. William Friedewald of the N.H.L.B.I., "the public attitude was fatalistic: 'You may get a heart attack or you may not.' Today Americans are beginning to realize their health is in their own hands." —By Claudia Wallis. Reported by Cheryl Crooks/Los Angeles, Patricia Delaney/ Washington and Sheila Gribben/Chicago, with other bureaus