Echocardiographic Criteria in IHSS

prone to CHD than would be expected if activity had no influence." The absence of a gradient by physical activity is all the more telling because the incidence of coronary heart disease among these men is extremely high, in keeping with much other evidence from Finland, despite the fact that most did heavy physical work. Karvonen says: "Interviews at the entry examinations showed that 71% of the East and 77% of the West Finns should be classified as being from very active to extremely active physically. The corresponding percentages of men classified as sedentary or indulging in only light activity were 11 and 9%, respectively. In both areas 69% of the men were farmers and lumberjacks. During the long, cold, dark winter most of the men work in the woods as loggers." In the face of these data and conclusions by Karvonen himself, how can it be maintained that physical activity is protective among these Finnish men? Therefore, I have not misquoted evidence but Dr. Mann, since he may be presumed to read Circulation, has suppressed it! Dr. Mann is also not correct in saying that I tried to "discount exercise." I have said, in my reply to Dr. Bassler (March 1974) that "more exercise will not by itself reduce the toll from coronary heart disease in the population" (the italics were used very deliberately). This, I do believe and would consider it tragic to think otherwise. FREDERICK H. EPSTEIN, M. D. Institute of Social and Preventive Medicine Zurich, Switzerland