Seiji Ozawa: How Cancer Can Cause Heart Failure

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Seiji Ozawa was a classical music conductor who was famous through an incredible number of recordings, radio and television appearances, and world tours. He was the lead conductor of the Chicago Symphony (1964–1968), the Toronto Symphony (1965–1969), the San Francisco Symphony (1970–1977), the Boston Symphony (1973–2002), and the Vienna State Opera (2002–2010). While other conductors wore tuxedos, Ozawa was known to wear a white turtleneck or an open-collared polo shirt with a colorful jacket. On February 4, 2024, at age 88, he died of heart failure caused by complications of the late stages of esophageal cancer.

An Early Start in Music
Ozawa was born in 1935 to Japanese parents in the Japanese-occupied Manchurian city of Mukden (now Shenyang) in China. He started taking piano lessons at age seven. At age nine, he moved with his family to Japan and started playing the piano for many hours each day. In 1950, at age 15, his anticipated piano career was ended when he broke two fingers while playing rugby. His piano teacher tried to lessen his disappointment by recommending that he become an orchestra conductor. He was so talented as a conductor that he was chosen to conduct the Japan Philharmonic while still a student.

After being graduated from music school at 22, Ozawa won the International Competition of Orchestra Conductors in Besançon, France. Charles Munch, the music director of the Boston Symphony orchestra, invited him to attend the Berkshire Music Center and study with him and with Pierre Monteux, another famous conductor. Ozawa then won the Koussevitzky Prize and an invitation to study with Herbert von Karajan in West Berlin. Next, Leonard Bernstein offered him the job of assistant conductor of the New York Philharmonic, and he spent the rest of his life conducting some of the world’s most famous major classical orchestras.

Personal Life
At age 27, he married classical pianist Kyoko Edo, and they divorced four years later. She died in January of 2024 at age 86, a few weeks before her ex-husband. At age 33, Ozawa married model and actress Miki “Vera” Irie, who was three-quarters Japanese and one-quarter Russian, and they had two children. During Ozawa’s years with the Boston Symphony Orchestra, the family spent a lot of time in Japan so the children would grow up knowing their Japanese culture.

Illness and Death
In 2010 at age 75, he was forced by the ravages of esophageal cancer to cancel all public appearances for six months. He never fully recovered from his cancer and he developed severe back problems. He valiantly tried to continue his musical activities and he performed his last concert on November 22, 2022 by conducting the Saito Kinen Orchestra in a wheelchair. He had spent 14 years becoming progressively less active until he was essentially bedridden, which most likely was the cause of the heart failure that killed him at age 88.

How Cancer Can Cause Heart Failure
Cancer is often such a painful and debilitating disease that the victims can become so weak that they move very little and lie in bed all the time. When you become inactive, you lose your skeletal muscles at an alarming rate, and any decrease in skeletal muscles, in turn, causes loss of heart muscle until your heart can become too weak to pump blood to your brain and you die.

Starling’s Law
In 1914, Doctor Ernest Starling described what is known today as “Starling’s Law,” which says that there is an increase in the force of contraction of the ventricles in response to an increase in the volume of blood returning to the heart (Circulation, 2002;106(23):2986-2992). Thus strengthening skeletal muscles strengthens your heart muscle and not the other way around. When you contract your skeletal muscles, they squeeze the veins near them to pump extra blood back to your heart. The extra blood flowing back to your heart fills up your heart, which stretches your heart muscle, causing the heart muscle to contract with greater force and pump more blood back your body. This explains why your heart beats faster and harder to pump more blood when you exercise. The harder your heart muscle has to contract, the greater the gain in heart muscle strength:

  • The larger your skeletal muscles, the stronger your heart and the less your chance of suffering heart diseases (J Epidem & Comm Health, Nov 11, 2019; Am J of Cardiology, Apr 15, 2016;117(8):1355-1360).
  • A study of almost a million adults with no history of heart disease followed for 10 years found that those who did not exercise were at 65 percent increased risk for strokes and heart attacks, the same rate as that found for smoking (Euro J of Prev Cardiology, Feb 10, 2020).
  • A study of 51,451 participants, followed for 12.5 years, found a strong association between exercise and decreased risk for heart failure (J Amer Col of Cardiol, Mar 2017;69(9)).
  • A study of 378 older adults showed that the smaller the muscles in their arms, legs and trunk, the smaller and weaker the upper and lower chambers of their hearts (J Am Geriatr Soc, Dec 2019;67:2568-2573).
  • Low skeletal muscle size predicted death in people who had chronic heart failure (Cardiology, March 25, 2019).

The constant exercise involved in the act of conducting may be a strong part of the reason that orchestra conductors often have long lives. Any kind of vigorous exercise strengthens your heart and helps to prolong your life, and continuing to exercise as you grow older is unquestionably associated with extending life (Biogerontology, Mar 2, 2016;17:567–580). See my report on Conductors Often Have Long Lives. Orchestra conductors are socially and physically different from most members of society; they tend to be richer and more educated, and their work does not expose them to industrial hazards (PLoS ONE, August 7, 2013;8(8):e71630).

Lessons from Ozawa’s Cancer and Heart Failure
Ozawa was diagnosed with esophageal cancer in 2010, at age 75, and he remained as active as he could during his final 14 years, conducting his final concerts from a wheelchair. Cancer is a horrible disease that can be so debilitating and those affected can become so weak that they are not strong enough to even get out of bed. Maintaining heart muscle strength requires maintaining skeletal muscle strength, so as skeletal muscles become smaller and weaker, so does the heart muscle. Eventually, the heart muscle can become so weak that it cannot pump adequate amounts of blood to your brain and you can die from lack of oxygen.

Seiji Ozawa
September 1, 1935 – February 6, 2024