The first clues to the causes of heart disease came from Norway. Before the Second World War, Norwegians enjoyed a very high standard of living—and a very high rate of angina and deaths from heart attacks. Then came the Nazi occupation.

From 1940 onwards, Norwegians no longer had tobacco. Many were forced into jobs that were physically hard. Their milk, cheese, and beef were exported to Germany, and they had to rely much more on fish as a staple food. As a nation, they lost weight and their blood pressures fell. At the same time, Norwegians were under great stress. For four years, they lived constantly with such fear and anxiety as we can hardly imagine today.

What happened to the heart attack rate under such conditions? It fell .. . steeply! There was also an even steeper drop in the numbers of hospital patients who had thromboses (blood clots) after surgery.

By 1947, only two years after the war ended, with the return of abundant food and cigarettes, and despite the immense relief from stress, the heart attack rates were rising again to the pre-war levels.

However, that Norwegian natural experiment, which was probably mirrored in countries such as the Netherlands, also occupied by the Nazis, has lessons for people today.

The first is that, even when the answers are obvious, it is almost impossible for people to accept them if it means having to adopt a completely new approach to life. It took until the 1980s for the medical profession to accept the implications of the Norwegian experience, and only then after many other studies had confirmed them. For nonmedical people, the message has still not penetrated, or it is not heeded, until they are suddenly faced with the possibility of their own mortality!

The second, and more encouraging, lesson from Norway is that it takes only a short time, less then a year, for a change in lifestyle to improve your chances of avoiding a heart attack and early death from heart disease. It does not seem possible that the lifestyle change could have reversed years of atheroma, but it may have made other differences to the supply-demand equation in the workings of the heart—such as making it much less easy for clots to form within the affected arteries.


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