A Tribute to Arthur Klatsky, MD (1929 – 2023)
We are all saddened by the death of Arthur Klatsky on April 30, 2023. Arthur was our colleague for years and a good friend of many of us who study alcohol consumption, health, and disease. As a physician and epidemiologist, Arthur made many important contributions to our current knowledge about the relation between drinking alcohol and health outcomes. He spent most of his career as a senior investigator of the Oakland Kaiser Permanente Medical Center, in California, using their huge database from decades of observations to discover genetic and environmental factors associated with health and longevity.
Born in New York City in 1929, at the onset of the Great Depression in the United States, Arthur became a magna cum laude graduate of Yale University and graduated from Harvard Medical School with Honors. In 1974, he published the first major scientific report on the relation between alcohol consumption and the risk of coronary heart disease, finding decreased risk for moderate drinkers in comparison with non-drinkers. These results represent the seminal epidemiologic findings leading to our understanding of a potential role of moderate alcohol consumption as part of a healthy diet and lifestyle. Subsequently, Arthur published many papers describing the net health outcomes associated with alcohol consumption.
Arthur’s research made it clear that the amount and the pattern of alcohol consumption helped determine if there were beneficial or harmful effects of drinking. He was one of the first scientists to describe the “J-shaped curve,” where regular light-to-moderate drinking without binges was more often associated with a beneficial effect on health, whereas binge or heavy drinking, especially without food, was more likely to be associated with increased risk of many diseases.
Arthur was the first investigator to demonstrate how “under-reporting” of alcohol consumption was an important factor in estimating health risks. Based on the huge database of the Kaiser-Permanente Cohort (from repeated evaluations over decades), among those patients reporting one to two drinks per day he classified those who had evidence of alcohol misuse (alcoholism, alcoholic liver disease, etc.) somewhere in their medical records as “likely under-reporters.” Those reporting one or two drinks/day without such data suggesting abuse were categorized as “unlikely under-reporters.” The association of disease outcomes was markedly different between the two categories, with higher risk of hypertension, breast cancer, and premature death being seen only among those at this reported level of drinking who had been categorized as “likely under-reporters.” These results clearly supported the absence of such harmful effects of alcohol among truly moderate drinkers.
Through the years, Arthur and Eileen, his wife of 69 years, joined us at national and international scientific meetings where he not only reported his own recent research but, equally important, presented what he thought was a balanced message to the public about drinking. His early recommendations, which have subsequently been strongly supported by later research, was that for most mature adults, a small amount of alcohol (especially wine) consumed with meals and without binge drinking tended to have protective effects for most of the diseases of ageing, including coronary heart disease, ischemic stroke, diabetes, and total mortality. Heavier drinking tended to be associated with harmful effects.
We in our Forum will miss Arthur not only for his intellectual input but for his gentle manner and soft-spoken wisdom. He and Eileen were wonderful participants in our meetings with our receptions and dinners. However, few of us could keep up with them when they undertook their long and strenuous hikes. Presumably, his regular exercise, good genes, and moderate food (and alcohol) intake, all contributed to his long and highly productive career.
The scientific community has lost an important leader who has helped us define what makes up a “healthy lifestyle,” and to clarify how moderate alcohol consumption with food can be an important component for most people. We will miss Arthur Klatsky as an intellectual force and as a friend and colleague.
Members of the International Scientific Forum on Alcohol Research
(View members here.)
May 5, 2023
There is an interesting interview with Art Klatsky MD on his work here: Klatsky, Arthur L. « Heart Attack Prevention (umn.edu)
A small selection of important publications:
Klatsky AL, Friedman GD, Siegelaub AB, Alcohol consumption before myocardial infarction. Results from the Kaiser-Permanente epidemiologic study of myocardial infarction. Ann Intern Med1974;81:294-301. doi:10.7326/0003-4819-81-3-294pmid:4850474
Klatsky AL, Friedman GD, Armstrong MA, The relationships between alcoholic beverage use and other traits to blood pressure: a new Kaiser Permanente study. Circulation1986;73:628-36. doi:10.1161/01.CIR.73.4.628pmid:3948365
Klatsky AL, Armstrong MA, Friedman GD, Sidney SAlcohol drinking and risk of hospitalization for ischemic stroke. Am J Cardiol2001;88:703-6. doi:10.1016/S0002-9149(01)01824-0pmid:11564405
Klatsky AL, Armstrong MA, Friedman GD, Relations of alcoholic beverage use to subsequent coronary artery disease hospitalization. Am J Cardiol1986;58:710-4. doi:doi:10.1016/0002-9149(86)90342-5pmid:3766412
Klatsky AL, Armstrong MA, Friedman GD, Sidney S, Alcohol drinking and risk of hemorrhagic stroke. Neuroepidemiology2002;21:115-22. doi:10.1159/000054808pmid:12006774
Bell S, Daskalopoulou M, Rapsomaniki E et al, Association between clinically recorded alcohol consumption and initial presentation of 12 cardiovascular diseases: population based cohort study using linked health records. BMJ2017;256:j909.
Alcohol and cardiovascular disease Editorial – BMJ 2017;356:j1340 Alcohol and cardiovascular disease https://doi.org/10.1136/bmj.j1340 (Published 22 March 2017)