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A tribute to Peter O. Kwiterovich Jr., MD
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By Roger S. Blumenthal, MD; and Michael Miller, MD
The field of preventive cardiology lost one of its great investigators, clinicians and mentors with the passing of Peter O. Kwiterovich Jr., MD, on Aug. 15. He died after a long battle with metastatic prostate cancer at age 74 years.
Affectionately known as “Pete” to his many friends and colleagues in academic medicine, he was an internationally known expert on atherosclerotic vascular disease. He was the founder and director of the Johns Hopkins University Lipid Clinic. His investigative and clinical work spanned more than 45 years and defined what was considered normal cholesterol values for children. He also helped demonstrate the safety of statin therapy in adolescents with familial hypercholesterolemia. His research helped to avert premature disability and death for thousands of individuals with inherited dyslipidemias.
Peter O. Kwiterovich Jr.*
His work shaped our current approach to screening and CVD prevention, and led to a better understanding of the evolution of atherosclerotic vascular disease from adolescence onward. The way that Kwiterovich set up the Lipid Clinic with a strong focus on lifestyle changes for the entire family was how we modeled the University of Maryland Preventive Cardiology Center and the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. He greatly enjoyed teaching several generations of students, house staff, fellows, patients and their families. He loved science and became a full professor at Johns Hopkins at age 44 years.
The son of a physician, Kwiterovich was exposed to science as a child. He graduated from the College of Holy Cross, and his interest in genetics was nurtured at Dartmouth Medical School and at Johns Hopkins School of Medicine under the direction of the late Victor McKusick, MD, who is often referred to as the father of medical genetics.
Roger S. Blumenthal
Kwiterovich completed his internship in pediatrics at Harvard’s Children’s Hospital and then worked for 3 years in the molecular disease branch at the NHLBI. It was at the NIH where he developed a passion for understanding and treating inherited disorders of cholesterol metabolism and also where he worked with Donald Fredrickson, MD, and Robert Levy, MD, on the metabolic basis of atherosclerotic vascular disease. He then completed his pediatrics residency at Johns Hopkins. Soon after, he received research funding from the NIH that allowed him to establish the Johns Hopkins University Lipid Clinic, which he directed until this past spring. His group often saw more than 2,000 pediatric and adult patients each year. The Johns Hopkins site he directed was selected to participate in the landmark Lipid Research Clinics Coronary Primary Prevention Trial, the first clinical trial demonstrating that cholesterol lowering using a bile acid sequestrant was associated with reduced risk for an initial CHD event.
In 1973, Kwiterovich wrote a seminal paper in The Lancet, titled “Neonatal Diagnosis of Familial Type-II Hyperlipoproteinemia,” which was cited by Brown and Goldstein in their Nobel Laureate manuscript published in Science in 1986.
Beginning in the late 1970s, Kwiterovich teamed up with Allan Sniderman, MD, after their discovery that apolipoprotein B was a better predictor of CHD risk than LDL cholesterol. In fact, Kwiterovich and Sniderman were among the first to identify increased CHD risk in association with relatively normal levels of LDL, if ApoB levels were elevated. Known as “hyperapoB,” this disorder has become increasingly recognized as an important contributor to increased CHD risk in young and middle-aged individuals.
Kwiterovich was one of the foremost pediatric lipid authorities in the United States and led investigations demonstrating the safety of low cholesterol and low saturated fat diets and statin use for adolescents with familial hypercholesterolemia. He was an outstanding lecturer, teacher and writer who would emphasize that atherosclerotic lesions begin in childhood and are directly related to traditional CVD risk factors.
Michael Miller
He emphasized a comprehensive integrated evaluation of all predisposing factors in family members of patients with premature vascular disease. As a member of the AHA Nutrition Committee, this was perhaps most eloquently represented in its 1982 statement: “The AHA has taken the position that education of the general public about hygienic measures to reduce CHD risk, and of physicians about detection and modification of risk factors, is the most appropriate approach to the prevention of CHD.”
For more than 2 decades, his annual lipid disorders training center CME basic and advanced courses taught a generation of physicians and trainees that inherited lipoprotein disorders often present in youth at high risk for future CHD, including familial hypercholesterolemia — caused by a defect in the LDL receptor — and familial combined hyperlipidemia and its metabolic cousin hyperapoB. The latter two are prototypes for the overproduction of VLDL in the liver.
In addition, he published three highly acclaimed books: Beyond Cholesterol – The Johns Hopkins Complete Guide for Avoiding Heart Disease (1989), Johns Hopkins Complete Guide to Preventing and Reversing Heart Disease (1998) and The Johns Hopkins University Textbook of Dyslipidemia (2010). The latter was recently translated into Chinese for use by medical professionals in Asia.
Beyond his scholarly activities, he will be remembered for his quick wit, jolly laugh, and kind and thoughtful demeanor. If you worked in Pete’s lab, you were expected to participate in birthday celebrations with delicious, often homemade high-fat cakes and pies. Other celebrations for grant awards included well-known Baltimore establishments like Bertha’s Mussels, crab cake restaurants and a good steakhouse.
Soft spoken and humble, he took an active interest in his students and their career paths as he did with his children, as noted by his son, Peter Jr., during a recent memorial service. He leaves behind his wife of 15 years, Martha, and their two children, Adam and Shelton. He is also survived by his former wife, Kathleen, and their three children, Kris Ann, an academic physician in Virginia, Peter Jr. and Karen.
Peter O. Kwiterovich Jr. was truly a leader in the fields of lipidology and atherosclerotic vascular disease. We were very fortunate to have had him as a close friend and mentor.
Roger S. Blumenthal, MD, is director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and is the CHD and Prevention Section Editor for Cardiology Today. Michael Miller, MD, is professor of medicine in the division of cardiology and professor of epidemiology and preventive medicine at University of Maryland School of Medicine, as well as director of the Center for Preventive Cardiology for the University of Maryland Medical System and staff physician at the Veterans Affairs Medical Center in Baltimore.
*Photo courtesy of Johns Hopkins Medicine