Peter Kwiterovich was an early advocate of cholesterol screening in children

Peter O. Kwiterovich Jr., M.D., professor emeritus of pediatrics and medicine at Johns Hopkins, one of the world’s foremost authorities on lipid disorders and a leading advocate for routine cholesterol screening in children, died on Aug. 15 after a long battle with prostate cancer. He was 74.

In a career that spanned nearly half a century, Kwiterovich established himself as one of the pre-eminent clinicians and scientists on familial lipid disorders, a group of inherited conditions marked by abnormal fat metabolism, exceedingly high cholesterol and early-onset heart disease. In the 1980s, Kwiterovich and a colleague, Allan Sniderman, for the first time revealed the biochemical findings and clinical features associated with high cholesterol and the propensity toward premature heart disease in certain families. The ensuing report led to a new understanding of early-onset heart disease and the role that elevated cholesterol plays in the development of this disorder.

“We have lost a true giant in the field of cardiovascular disease,” says George Dover, M.D., pediatrician-in- chief at The Johns Hopkins Hospital and director of the Johns Hopkins Children’s Center. “Peter’s lab and clinic were pioneers in defining lipid disorders and premature atherosclerosis in families with genetic predisposition to strokes and heart disease. His work transformed our understanding of fat metabolism and lipid malfunction and the role they play in fueling premature heart disease.”

Kwiterovich’s work not only helped define normal values for cholesterol in children, but also led to new therapies to slow or halt the progression of heart disease and avert premature death among thousands of families.

 “Peter Kwiterovich was a legendary figure in preventive cardiology and atherosclerosis management,” says Roger Blumenthal, M.D., professor of medicine and director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. “His work was an early catalyst that not only reshaped our approach to screening and prevention, but also helped fill in some important gaps in our understanding of the evolution of heart disease across the life spectrum, showing that the most common form of the disease begins at a far younger age than many had suspected.”

“Peter Kwiterovich was an internationally recognized leader in the field of lipid biology and its relationship to cardiovascular diseases,” says Gordon Tomaselli, M.D., director of cardiology at Johns Hopkins. “He embodied the spirit of Johns Hopkins in his unwavering pursuit of the discovery of new knowledge and its application to improving the lives of his patients. He was a friend, colleague and mentor to many of us at Hopkins.”

In 1972, Kwiterovich founded the Johns Hopkins Lipid Clinic, which he directed until his retirement in 2014. The clinic attracted pediatric and adult patients from near and far — Kwiterovich saw more than 2,000 patients a year — a number that gave investigators a rare opportunity to collect and compare biochemical and genetic data across multiple generations. But beyond that, the clinic served as a training site for specialists in adult and pediatric cardiology and endocrinology. Indeed, many of his mentees blossomed into prominent clinicians and scientists themselves, and some went on to become professors and chairs of academic departments across the United States, Europe, Australia and Israel.

Kwiterovich also founded the division of Lipid Research and Atherosclerosis in the Department of Pediatrics at the Johns Hopkins University School of Medicine, the first of its kind in academic pediatrics. Spawned by insights generated by Kwiterovich’s research and clinical observations, the division remains one of a handful of such academic pediatric divisions in the country. 

Kwiterovich began studying the biochemical basis of cholesterol and heart disease in the 1960s, an era when atherosclerotic heart disease — the most common type of heart disease, marked by abnormal fatty buildups in the blood vessels — was deemed a purely adult problem, affecting mostly older men. Kwiterovich, focused on children and families with a group of rare genetic disorders in which the body’s ability to process and rid itself of cholesterol is severely compromised. Following an Amish family for more than 25 years, Kwiterovich studied a disorder known as phytosterolemia, which is marked by the development of golf ball size cholesterol deposits, or xanthomas. Insights from this research revealed the molecular defect responsible for this disorder and led to the discovery of two proteins, ABCG5 and ABCG8, involved in the ferrying of lipids in and out of cells.

Gradually, Kwiterovich’s observations led him to believe that high cholesterol is a public health problem that affects both children and adults. He suspected, and later showed, that coronary artery disease begins early in life, a finding that led him to advocate for regular screening in childhood and for early pre-emptive treatment among those affected. He led several landmark studies on therapies to control abnormal lipid levels in children, and was an early investigator of the safety and efficacy of cholesterol-lowering drugs in children. 

He was one of the lead investigators on a multicenter trial that found a low-fat diet is safe for teens with moderately high cholesterol. The results of the study helped assuage concerns among parents and pediatricians alike that a low-fat diet could pose a threat to a teenager’s rapidly growing body.

“Peter conducted relentless research, developed innovative clinical approaches and forged passionate advocacy for children at risk of coronary artery disease,” says Joel Brenner, M.D., director of pediatric cardiology at the Johns Hopkins Children’s Center. “He was among the earliest and most ardent advocates of early cholesterol screening in children as a way to prevent heart disease in adulthood.”

More recently, Kwiterovich launched a novel, alternative cholesterol-lowering therapy at Johns Hopkins known as LDL apheresis, a treatment reserved for a small group of patients with familial hypercholesterolemia, a genetic disorder marked by the body’s inability to remove LDL from the bloodstream, leading to rapid accumulation of fat in the blood vessels.

In addition to being a prolific researcher and a devoted clinician, Kwiterovich was a passionate and engaging teacher, those who worked with him say.

“He loved to teach and remained a masterful teacher,” says cardiovascular nurse practitioner Kathy Byrne, C.R.N.P. “He encouraged me to develop my own approach in caring for patients and to be creative in prescribing and managing therapies. Most importantly, he has been an inspiration for me to ‘think outside the box’ when evaluating and managing patients.”

In addition to his incisive intellect and academic curiosity, Kwiterovich possessed a deeper wisdom and sense of humor that transcended the purely intellectual, those who knew him say.

“He was a great friend and mentor to me,” Blumenthal says. “We will miss his wit and wisdom, but we learned so much from him. He had a sly grin and a great laugh.”

Kwiterovich earned his medical degree from the Johns Hopkins University School of Medicine in 1966 and completed an internship in pediatrics at Boston Children’s, followed by three years in the molecular disease branch of the National Heart, Lung and Blood Institute. He then returned to Johns Hopkins to complete his residency in pediatrics.

Kwiterovich wrote two popular clinical texts, The Johns Hopkins Complete Guide to Preventing and Reversing Heart Disease and Beyond Cholesterol: The Johns Hopkins Complete Guide for Avoiding Heart Disease, which won the American Heart Association’s Howard W. Blakeslee Award as the best book of the year in its field. Kwiterovich was the editor of The Johns Hopkins Textbook of Dyslipidemia, a comprehensive textbook on all aspects of caring for children and adults with lipid disorders, published in 2009. He authored more than 200 peer-reviewed publications and 75 academic reviews and book chapters.

Among Kwiterovich’s many awards and honors, in addition to the Blakeslee Award, he has been listed twice in The Best Doctors in the U.S., in several editions of Who’s Who in America and in the World, and in American Men and Women of Science. Kwiterovich is also a recipient of the American Heart Association’s Helen B. Taussig Award.

Kwiterovich is survived by his wife, Martha Kwiterovich and their children, Adam Kwiterovich and Shelton Kwiterovich; former wife, Kathleen Ann Justin, and their children, Kris Ann K. Oursler, M.D., Peter Oscar Kwiterovich III, Ed.D., Karen Perritt; five grandchildren, James Perritt Jr., Charles Perritt, Charlotte Lane Axton Wettlaufer, Peter Oscar Kwiterovich IV, and Sloane Lane Kwiterovich; and his sisters, Pamela Skwish and Deborah Kwiterovich-Hoover.

Visitation will take place from 2 p.m. to 4 p.m. and from 6 p.m. to 8 p.m. on Tuesday, Aug. 19, at the Ruck Funeral Home, 1050 York Road. A funeral mass will be held at 2 p.m. on Wednesday, Aug. 20, at the Cathedral of Mary Our Queen, 5200 North Charles St. in Baltimore.

Arrangements are pending for a memorial service at Johns Hopkins.