Memorable Cardiology Quotes
Barry A. Franklin, PhD*
For ⬎3 decades, my career has focused on preventive
health issues and evidence-based medicine, with specific
reference to the primary and secondary prevention of cor-
onary artery disease. I’ve been privileged to work at a major
university-based medical center and, more recently, 1 of the
finest hospitals in the nation, soon to be affiliated with a new
medical school. Accordingly, my clinical and academic
responsibilities are typical of many faculty members and
include patient evaluation, treatment, and counseling; re-
search; professional volunteer service; and teaching under-
graduate and graduate students as well as medical students,
residents, and cardiology fellows. I’ve also regularly re-
viewed manuscripts for numerous scientific and clinical
journals and have given many invited presentations to local,
state, national, and international medical and lay audiences.
Almost invariably, after a talk, I’m inundated with snail
mail, e-mail, and personal requests for slides. No, not data
or trial methods, but rather requests for cartoons, joke slides,
and, perhaps most of all, the “memorable cardiology
quotes” from interviews, presentations, or publications that
I’ve shared from esteemed colleagues and past and present
authorities. Listed here are some of the favorites (and their
sources) that I’ve used in my teaching and presentations
over the years, with specific reference to preventive cardi-
ology. I’ve listed them under the following general catego-
ries: the individual “at risk”; coronary angiography and
angioplasty; diagnostic testing; heart-healthy eating; exer-
cise, physical activity, and obesity; cardiovascular risk re-
duction; and patient counseling. Although most quotations
are as applicable (and accurate) today as they were when
they were originally put forth, a few clearly missed the mark
and were subsequently discounted.1
The Individual “At Risk”
“Another point to remember is that angina pectoris is,
like gout, a disease of men, and not women. When it does
manifest itself in females, as is occasionally the case, it is
often so confused with the common and frequent pains in
the left side, due to flatulence or other causes, to which that
sex is especially prone, that its recognition may be a matter
of some difficulty.”
—Prof. P. Brouardel and F. Lucas Benham, MD, 19021
“Who is the person least likely to have a heart attack? He
is an effeminate municipal worker or embalmer, completely
lacking in physical and mental alertness. He has no drive,
ambition or competitive spirit. He never has attempted to
Department of Medicine, Division of Cardiology (Cardiac Rehabilita-
tion and Exercise Laboratories), William Beaumont Hospital, Royal Oak,
Michigan. Manuscript received September 16, 2008; revised manuscript
received and accepted September 17, 2008.
*Corresponding author: Tel: 248-655-5766; fax: 248-755-5751.
E-mail address: bfranklin@beaumont.edu (B.A. Franklin).
Am J Cardiol 2009;103:428 – 430
0002-9149/09/$ – see front matter © 2009 Published by Elsevier Inc.
doi:10.1016/j.amjcard.2008.09.097
meet a deadline. He has a poor appetite, subsisting on fruits
and vegetables. He detests tobacco. He spurns ownership of
a television set or motor car. He has a full head of hair and
is scrawny, unathletic in appearance, yet is constantly
straining his puny muscles by exercise. He is low in income,
blood pressure, blood sugar, uric acid and cholesterol. He
has been on nicotinic acid, pyridoxine, and long-term anti-
coagulant therapy ever since his prophylactic castration.”
—Irvine H. Page, MD (1901–1991)
“The central problem in heart failure is not that patients
are short of breath or that they retain fluid: the problem is
that they die. Heart failure is a mortal illness, more serious
than most malignancies.”
—Arnold M. Katz, MD
Coronary Angiography and Angioplasty
“It’s not the hole in the doughnut where the action is. It’s
the doughnut itself.”
—Steven E. Nissen, MD
“Angioplasties are a little like potato chips. You can’t
have just one.”
—William Castelli, MD
“We know PCI in the setting of an acute coronary
syndrome saves lives, but 85% of PCIs in the U.S. are done
in stable patients, and of those I’d bet that at least 25% are
asymptomatic patients. This study [Clinical Outcomes Uti-
lizing Revascularization and Aggressive Drug Evaluation]
clearly shows something we all knew— but many did not
want to believe—that angioplasties don’t save lives, except
in acutely ill patients, and don’t prevent heart attacks.”
—James H. Stein, MD
Diagnostic Testing
“Reading a technically poor echocardiogram is like
looking at a polar bear in a snow storm.”
—Lynn Y. Zoiopoulos, DO
Heart-Healthy Eating
“The whiter the bread, the sooner you’re dead.”
—Zonya Foco, RD
“How do you make a hot dog? First you slaughter the
animals and cut out all the good parts, the steaks and chops.
But you’ve got a lot of animal left and what are you going
to do with it? The hot dog industry took off when a clever
guy invented a machine that works like a kitchen disposal—
you dump everything in, eyeballs and all, and grind it up.
Voila, the hot dog.”
—William Castelli, MD
“We now believe it’s the newest lipid deposits—where
that greasy cheeseburger you just ate landed—that rupture
and precipitate the majority of heart attacks. These deposits
don’t impinge on blood flow while on artery walls, but they
www.AJConline.org
 Editorial/Memorable Cardiology Quotes
are unstable and easily rupture to block a coronary vessel.
The good news is that these young unstable deposits can be
shrunk. Even if you have a heart attack, after two years of
lowering your cholesterol, you can dramatically reduce your
risk of another attack. There have been numerous studies on
reversibility, and they all show that if you really get the
numbers down, the lesions in your arteries start to shrink.”
—William Castelli, MD
“If you can’t be a vegetarian yourself, the next best thing
is to eat a vegetarian from the sea. These are the mollusks—
mussels, clams and oysters—the animals that are rock-
bottom lowest in saturated fat. Even the crustaceans—
shrimp and lobster, for example—are better to eat than the
white breast of chicken without the skin because they are so
low in saturated fat. The cholesterol in crustaceans has been
recently reanalyzed and found to be much lower than we
used to think. You can eat two dozen shrimp and still take
in only 200 of the 300 milligrams of cholesterol allowed in
a day.”
—William Castelli, MD
“Our excessive intake of meat is killing us. We fatten our
cows and pigs, kill them, eat them, and then they kill us!”
—William C. Roberts, MD
Exercise, Physical Activity, and Obesity
“We doctors can now state from our experience with
people, both sick and well, and from a growing series of
scientific researches that ‘keeping fit’ does pay richly in
dividends of health and longevity.”
—Paul Dudley White, MD
“Vigorous physical activity both protects against and
provokes acute cardiac events.”
—Paul D. Thompson, MD
“As a general rule, moderate activity is less harmful to
health than inactivity. You could also put it this way: a
medical evaluation is more urgent for those who plan to
remain inactive than for those who intend to get into good
physical shape.”
—Per-Olof Åstrand, MD
“Exercise training? An agent with lipid-lowering, an-
tihypertensive, positive inotropic, negative chronotropic,
vasodilating, diuretic, anorexigenic, weight-reducing, ca-
thartic, hypoglycemic, tranquilizing, hypnotic and anti-
depressive qualities.”
—William C. Roberts, MD
“The most likely explanation for the current obesity
epidemic is a continued decline in energy expenditure that
has not been matched by an equivalent reduction in energy
intake.”
—James O. Hill, PhD
“In the prospective Danish Diet, Cancer and Health
Study, overweight (body mass index, 25 to 29.9 kg/m2) and
obesity (body mass index ⱖ 30 kg/m2) were associated with
a higher risk of acute coronary syndrome (ACS) among the
physically active and inactive, in nonsmokers and smokers,
and among those who adhered more or less to a heart-
healthy dietary pattern. After multivariable adjustments,
each unit of body mass index was associated with a 5%
429
and 7% higher risk of ACS among women and men,
respectively.”
—Majken K. Jensen, MSc
“Although physical activity or exercise training may not
make all people lean, it appears that an active way of life has
important health benefits, even for those who remain
overweight/obese.”
—Steven N. Blair, PED
“Exercise-based cardiac rehabilitation programs should
incorporate the types of muscular effort that correspond to
that required for the person’s daily activity, including se-
lected forms of static and dynamic arm exercise. In actual-
ity, few occupational and leisure-time activities require sus-
tained walking or jogging. Examples include: postmen,
protective service personnel, police officers, and their
fugitives.”
—Herman K. Hellerstein, MD (1913–1993)
“From a public health perspective, the emphasis on get-
ting sedentary adults to become moderately active is highly
appropriate; the evidence shows that on a population-wide
basis, this is where the majority of the health benefits are to
be obtained.”
—Steven N. Blair, PED
Cardiovascular Risk Reduction
“The way to lead a long life is to get a chronic disease
and take care of it.”
—Sir William Osler, MD (1849 –1919)
“The thing that is essential about hypertension is that it
be treated.”
—Ira M. Grais, MD
“A strong case can be made for there being a single
absolute atherosclerotic risk factor and that atherosclerosis
does not occur when that factor is missing. In my view the
only absolute, unequivocal, independent atherosclerotic risk
factor is an elevated serum total or LDL cholesterol level, a
low HDL cholesterol level, or both.”
—William C. Roberts, MD
“Statin drugs, in my view, are the best cardiovascular
drugs ever created, in that they have the greatest potential to
prevent atherosclerotic plaques and their complications, and
they also have the greatest potential to arrest plaque forma-
tion, and therefore, to prevent additional atherosclerotic
events. These drugs are to atherosclerosis what penicillin
was to infectious diseases.”
—William C. Roberts, MD
“Recent data (using IVUS) show that approximately
85% of individuals in the U.S. over age 50 have atheroscle-
rotic coronary disease. So for me, the question isn’t whether
middle-aged and older adults have heart disease—they
probably do. It’s how to prevent acute cardiac events.”
—Ira M. Grais, MD
“Smoking, body-mass index, and exercise patterns in
midlife and late adulthood are predictors of subsequent
disability. Not only do persons with better health habits
survive longer, but in such persons, disability is postponed
and compressed into fewer years at the end of life.”
—James F. Fries, MD
430 The American Journal of Cardiology (www.AJConline.org)
Patient Counseling
“The healing process demands more than science; it
requires mobilizing patient’s positive expectations and stim-
ulating faith in physician’s ministrations. I know of few
remedies more powerful than a carefully chosen word. Pa-
tients crave caring, which is dispensed largely with words.
Talk, which can be therapeutic, is one of the underrated
tools in a physician’s armamentarium.”
—Bernard Lown, MD
In closing, I’m reminded of 2 other quotations that are
fundamental to any discussion of enduring teaching and
mentorship. Sir Isaac Newton said, “If I have seen fur-
ther . . . it is by standing upon the shoulders of giants.”
The late Earl Nightingale echoed these sentiments when he
stated, “A candle is not diminished by giving another candle
light.” Although many of our best teachers in cardiology are
no longer with us, their candles continue to light the candles of
others through their speaking, writing, and the students they
touched. Their works stand as beacons of light, shining as
brightly today as they did when they were first promulgated.
Unfortunately, many of our past and present cardiology con-
temporaries, especially in the current era of information access
and exchange, probably have no idea of the vast number of
candles they’ve lit over the years. I was one of them.
1. Brouardel P, Benham FL. Death and Sudden Death. New York: William
Wood, 1902:145.