Cardiac Events and Nuclear war: Prevention by Cardiovascular Specialists

James E. Muller, MD; John O. Pastore, MD; Amir Lerman, MD


Circulation. 2019;139(25):2597-2599. 

In This Article

Cardiologists at the Forefront

The cardiovascular events we work to prevent—sudden cardiac death, myocardial infarction, rupture of an aneurysm, stent thrombosis, and stroke—are low-probability, high-consequence negative events. These catastrophic occurrences threaten our patients in much the same way that nuclear war threatens humanity. This similarity is the likely reason that cardiologists played a major role in reducing nuclear risk during the Cold War.

Our colleagues in physics alert us to the degree of nuclear threat by moving the hands on the Doomsday Clock of the Bulletin of the Atomic Scientists. In 2018, they moved the hands forward to 2 minutes before midnight, the closest to disaster since 1953 when the Soviets developed a hydrogen bomb, creating the threat of a war between nuclear-armed states. The physicists attribute the current increase in nuclear risk to proliferation to 9 nations, terrorism, the increased complexity of the computer systems governing the weapons, the threat of nuclear war between North Korea and the United States, and the possible end of the United States–Russia Intermediate Nuclear Weapons treaty.

Peaks in risk occur at times of national conflict and when nuclear war–fighting ideas are not counterbalanced by public opposition. As in the 1980s, the concept that a "limited" nuclear war could be won has entered the thinking of government leaders, and a new, costly United States–Russia nuclear arms race is underway.

It can be argued that nuclear weapons policy is best managed by governmental leaders, leaving little role for the individual, let alone a special role for cardiovascular professionals. But cardiologists have made major contributions to reducing prior nuclear threats. In the 1960s, as the Cold War limited peaceful contacts, Dr Paul Dudley White worked closely with Dr Alexander Myasnikov to build a United States–Russia medical bridge to decrease tensions. In 1962, Dr Bernard Lown, Dr Sidney Alexander, and colleagues alerted the public to the medical consequences of the use of nuclear weapons. At the height of the Cold War, cardiologists played a major role by founding International Physicians for Prevention of Nuclear War. This work included a televised discussion from Moscow organized by Dr Eugene Chazov in 1982 in which 3 Russian and 3 US physicians spoke against the arms race to millions of Russians and Americans. Four of the 6 physicians in the video were cardiologists.

The Nobel Committee awarded the 1985 Nobel Peace Prize to the International Physicians for Prevention of Nuclear War. The committee recognized the ability of physicians to help the public visualize threats and to communicate complex scientific issues in understandable terms. Since 1985, the number of nuclear weapons worldwide has decreased from >60 000 to ≈15 000. In 2007, the International Physicians for Prevention of Nuclear War cofounded the International Campaign to Abolish Nuclear Weapons, which won the 2017 Nobel Peace Prize.

Although cardiac risk may be low in any given year, cardiologists act on the basis of cumulative risk over a decade or a lifetime. For the nuclear threat, which has a low annual risk, we must think in terms of the lifetime of humanity. A 1% annual risk of nuclear war, started by intention or by accident, rises to a 50% risk over a 70-year period.

Prevention of cardiac events in most cases requires a change in behavior: cessation of smoking, taking medications for hypertension, weight loss. For the nuclear threat, Einstein stated that the prevention of nuclear war also requires a difficult change in high-risk and potentially modifiable behavior. We must recognize that in the nuclear era destructive force can no longer be the ultimate guarantor of security. Paradoxically, at moments of greatest danger, when the threat is most visible, the possibility of change is greatest—a linkage familiar to cardiologists when a lifelong smoker quits after having a heart attack.