The epidemic of the 20th century: Coronary heart disease

James E. Dalen, Joseph S Alpert, Robert J. Goldberg, Ronald S Weinstein

Research output: Contribution to journalArticle

82 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)807-812
Number of pages6
JournalAmerican Journal of Medicine
Volume127
Issue number9
DOIs
StatePublished - Sep 1 2014

Fingerprint

Coronary Disease
Heart Diseases
Myocardial Infarction
Coronary Artery Disease
Primary Prevention
Cause of Death
Aptitude
Secondary Prevention
Autopsy
Electrocardiography
Smoking
Cholesterol
Mortality
Incidence
Serum

Keywords

  • Acute myocardial infarction
  • Coronary atherosclerosis
  • Coronary heart disease
  • Primary prevention
  • Secondary prevention
  • Sudden cardiac death

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The epidemic of the 20th century : Coronary heart disease. / Dalen, James E.; Alpert, Joseph S; Goldberg, Robert J.; Weinstein, Ronald S.

In: American Journal of Medicine, Vol. 127, No. 9, 01.09.2014, p. 807-812.

Research output: Contribution to journalArticle

Dalen, James E. ; Alpert, Joseph S ; Goldberg, Robert J. ; Weinstein, Ronald S. / The epidemic of the 20th century : Coronary heart disease. In: American Journal of Medicine. 2014 ; Vol. 127, No. 9. pp. 807-812.
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