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The Epidemic of the 20th Century: Coronary Heart Disease

      Abstract

      Heart disease was an uncommon cause of death in the US at the beginning of the 20th century. By mid-century it had become the commonest cause. After peaking in the mid-1960s, the number of heart disease deaths began a marked decline that has persisted to the present. The increase in heart disease deaths from the early 20th century until the 1960s was due to an increase in the prevalence of coronary atherosclerosis with resultant coronary heart disease, as documented by autopsy studies. This increase was associated with an increase in smoking and dietary changes leading to an increase in serum cholesterol levels. In addition, the ability to diagnose acute myocardial infarction with the aid of the electrocardiogram increased the recognition of coronary heart disease before death. The substantial decrease in coronary heart disease deaths after the mid-1960s is best explained by the decreased incidence, and case fatality rate, of acute myocardial infarction and a decrease in out-of-hospital sudden coronary heart disease deaths. These decreases are very likely explained by a decrease in coronary atherosclerosis due to primary prevention, and a decrease in the progression of nonobstructive coronary atherosclerosis to obstructive coronary heart disease due to efforts of primary and secondary prevention. In addition, more effective treatment of patients hospitalized with acute myocardial infarction has led to a substantial decrease in deaths due to acute myocardial infarction. It is very likely that the 20th century was the only century in which heart disease was the most common cause of death in America.

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      References

      1. National Heart, Lung and Blood Institute (NHLBI). Disease statistics. In: NHLBI Fact Book, Fiscal Year 2012. Available at: http://www.nhlbi.nih.gov/about/factpdf.htm. Accessed March 31, 2014.

        • Jones D.S.
        • Podolsky S.H.
        • Greene J.A.
        The burden of disease and the changing task of medicine.
        N Engl J Med. 2012; 366: 2333-2338
        • Centers for Disease Control and Prevention (CDC)
        Decline in deaths from heart disease and stroke—1900-1999.
        MMWR Morb Mortal Wkly Rep. 1999; 48: 649-656
        • American Heart Association
        Heart disease and stroke statistics 2013 update.
        Circulation. 2013; 127: e6-e245
        • Cole H.M.
        • Fiore M.C.
        The war against tobacco 50 years and counting.
        JAMA. 2014; 311: 131-132
        • Herrick J.B.
        Clinical features of sudden obstruction of the coronary arteries.
        JAMA. 1912; 59: 2025
        • Herrick J.B.
        Concerning thrombosis of coronary arteries.
        Trans Assoc Am Physicians. 1918; 33: 408-418
      2. National Heart, Lung and Blood Institute (NHLBI). Morbidity & Mortality: 2012 Chart Book on Cardiovascular, Lung and Blood Diseases. Available at: http://www.nhlbi.nih.gov/resources/docs/2012_ChartBook_508.pdf. Accessed May 16, 2014.

        • Strong J.P.
        • Malcom G.T.
        • McMahan C.A.
        • et al.
        Prevalence and extent of atherosclerosis in adolescents and young adults.
        JAMA. 1999; 281: 727-735
        • Enos W.
        • Holmes R.H.
        • Beyer J.
        Coronary disease among United States soldiers killed in action in Korea.
        JAMA. 1953; 152: 1090-1093
        • McNamara J.J.
        • Molot M.A.
        • Stremple J.F.
        • et al.
        Coronary artery disease in combat casualties in Vietnam.
        JAMA. 1971; 216: 1185-1187
        • Webber B.J.
        • Seguin P.G.
        • Burnett D.G.
        • et al.
        Prevalence of and risk factors for autopsy-determined atherosclerosis among US service members, 2001-2011.
        JAMA. 2012; 308: 2577-2583
        • Dalen J.E.
        The moribund autopsy: DNR or CPR?.
        Arch Intern Med. 1997; 157: 1663
        • Hoyert D.L.
        The changing profile of autopsied deaths in the United States, 1972-2007.
        NCHS Data Brief. 2011; 67: 1-8
        • Elveback L.
        • Lie J.T.
        Continued high incidence of coronary artery disease at autopsy in Olmsted county, Minnesota, 1950 to 1979.
        Circulation. 1984; 70: 345-349
        • Roger V.L.
        • Weston S.A.
        • Killian J.M.
        Time trends in the prevalence of atherosclerosis: a population-based autopsy study.
        Am J Med. 2001; 110: 267-273
        • Carroll M.D.
        • Kit B.K.
        • Lacher D.A.
        • et al.
        Trends in lipids and lipoproteins in US adults, 1988-2010.
        JAMA. 2012; 308: 1545-1554
        • Johnson C.L.
        • Rifkind B.M.
        • Sempos C.T.
        • et al.
        Declining serum total cholesterol levels among US adults.
        JAMA. 1993; 269: 3002-3008
        • Lovastatin Study Group II
        Therapeutic response to lovastatin (mevinolin) in nonfamilial hypercholesterolemia. A multicenter study.
        JAMA. 1986; 256: 2829-2834
        • Chait A.
        • Brunzell J.D.
        • Denke M.A.
        • et al.
        Rationale of the diet-heart statement of the American Heart Association. Report of the nutrition committee.
        Circulation. 1993; 88: 3008-3029
        • Caggiula A.W.
        • Christakis G.
        • Farrand M.
        • et al.
        The multiple risk factor intervention trial (MRFIT) IV. Intervention on blood lipids.
        Prev Med. 1981; 10: 443-475
        • Centers for Disease Control and Prevention (CDC)
        Prevalence of coronary heart disease- United States 2006-2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 1377-1381
        • Kuller L.
        • Lilienfeld A.
        • Fisher R.
        Epidemiological study of sudden and unexpected deaths due to arteriosclerotic heart disease.
        Circulation. 1966; 34: 1056-1068
        • Goldberg R.J.
        • Gorak E.J.
        • Yarzebski J.
        • et al.
        A community wide perspective of sex differences and temporal trends in the incidence and survival rates after acute myocardial infarction and out of hospital deaths caused by coronary heart disease.
        Circulation. 1993; 87: 1947-1953
        • Arciero T.J.
        • Jacobsen S.J.
        • Reeder G.S.
        • et al.
        Temporal trends in the incidence of coronary disease.
        Am J Med. 2004; 117: 228-233
        • Ferguson J.L.
        • Beckett G.J.
        • Stoddart M.
        • et al.
        Myocardial infarction redefined: the new ACC/ESC definition, based on cardiac troponin increases the apparent incidence of infarction.
        Heart. 2002; 88: 343-347
        • Kong M.H.
        • Fonarow G.C.
        • Peterson E.D.
        • et al.
        Systematic review of the incidence of sudden cardiac death in the United States.
        J Am Coll Cardiol. 2011; 57: 794-801
        • Zheng Z.J.
        • Croft J.B.
        • Giles W.H.
        • et al.
        Sudden cardiac death in the United States, 1989 to 1998.
        Circulation. 2001; 104: 2158-2163
        • Cobb L.A.
        • Fahrenbruch C.E.
        • Olsulka M.
        • et al.
        Changing incidence of out-of-hospital ventricular fibrillation, 1980-2000.
        JAMA. 2002; 288: 3008-3013

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