The Coronary Heart Disease Pandemic in the Twentieth Century

Emergence and Decline in Advanced Countries

William G. Rothstein

• Publisher: CRC Press
• Year: 2017
• Print ISBN: 9781138569508
• eBook ISBN: 9781351337410
• Edition: 1
• Topic: Medicine
• Subtopic: Cardiology

This book demonstrates that a pandemic of coronary heart disease occurred in North America, western and northern Europe, and Australia and New Zealand from the 1930s to about 2000. At its peak it caused more deaths than any other disease. The book examines and compares trends in coronary heart disease mortality rates for individual countries. The most detailed analyses are for the United States, where mortality rates are examined for race, sex, and age groups and for geographic regions. Popular explanations for the rise and fall of coronary heart disease mortality rates are examined.

Contents

List of the Tables

Introduction

1. Pandemics as Historical Events

Pandemics of Infectious and Chronic Diseases

Criteria for Pandemics

Conclusion

References

2. Overview of the coronary heart disease pandemic in the united states and methods of analysis

Overview of the Coronary Heart Disease Pandemic

Characteristics of and Risk Factors for Coronary Heart Disease

Coronary Heart Disease and Disease Classification Systems

Methods of Analysis

References

3. The Emergence of the Coronary Heart Disease Pandemic in the United States, 1910-1935

Increases in Coronary Heart Disease Mortality Rates

References

4. The Coronary Heart Disease Pandemic in the United States from 1940 to 1967

The Coronary Heart Disease Pandemic in 1940

The Pandemic from 1950 to 1967

Coronary Heart Disease and Socioeconomic Position

References

5. Explanations for the emergence of the coronary heart disease pandemic

References

6. State Differences in Coronary Heart Disease Mortality Rates in the United States in 1950 and 1960

States with the Highest and Lowest Arteriosclerotic Heart Disease Mortality Rates in 1950 and 1960

References

7. The emergence of the coronary heart disease pandemic in canada and england and wales

Coronary Heart Disease Mortality Rates in Canada

Coronary Heart Disease Mortality Rates in England and Wales

Conclusion

References

8. The Peak and Decline of the Coronary Heart Disease Pandemic in the United States, 1970-2010

The Peak Years of the Coronary Heart Disease Pandemic

The Decline of the Coronary Heart Disease Pandemic

Ischemic Heart Disease Mortality Rates among the Very Old in the Twenty-First Century

References

9. Explanations for the Decrease in Ischemic Heart Disease Mortality Rates in the United States from 1970 to 2010

References

10. Decreases in State Ischemic Heart Disease Mortality Rates, 1970-1990

Decline of the Coronary Heart Disease Pandemic in the States

References

11. The Peak and Decline of the Pandemic in Canada, England and Wales, Western Europe, Australia, and New Zealand

The Peak and Decline of the Pandemic in Canada

The Peak and Decline of the Pandemic in England and Wales

The Peak and Decline of the Pandemic in Western Europe

The Peak and Decline of the Pandemic in Australia and New Zealand

References

12. Coronary heart disease after the pandemic

The Coronary Heart Disease Pandemic in the Twentieth Century

The Decline of the Coronary Heart Disease Pandemic

Coronary Heart Disease after the Pandemic: A Disease of the Elderly

Failure of the Coronary Heart Disease Pandemic to Spread to Central and South America

Ischemic Heart Disease Risk Factors in Healthy Persons in the Twenty-First Century

Prevention of Ischemic Heart Disease in the Twenty-First Century

Conclusion

References

Index

List of the Tables

1.1 United States Tuberculosis Mortality Rates by Age, Sex, and Race, 1914-1950 (Rates per 1,000 persons)

3.1 Mortality Rates from Coronary Heart Disease and All Causes by Age, Race, and Sex for Metropolitan Industrial Life Insurance Policyholders, 1911-1935 (Annualized average or annual rates per 1,000 policyholders)

3.2 Mortality Rates from Selected Diseases by Race and Sex, Metropolitan Industrial Life Insurance Policyholders Ages 45-74, 1911-1935 (Age adjusted annualized average mortality rates per 1,000 policyholders)

4.1 United States Mortality Rates from Coronary Heart Disease and All Causes by Age, Race, Sex, and City Population, 1940 (Rates per 1,000 persons)

4.2 United States Mortality Rates from Arteriosclerotic Heart Disease and All Causes by Age, Sex, and Race, 1950-1967 (Rates per 1,000 persons)

4.3 United States Age-Adjusted Mortality Rates for Selected Artery-Related Diseases, 1960 (Rates per 1,000 persons)

6.1 Characteristics of States with Highest Arteriosclerotic Heart Disease Mortality Rates for White Men and Women, 1950 and 1960 (State age adjusted mortality rates per 1,000 persons)

6.2 Characteristics of States with Lowest Arteriosclerotic Heart Disease Mortality Rates for White Men and Women, 1950 and 1960 (State age adjusted mortality rates per 1,000 persons)

7.1 Canada Arteriosclerotic Heart Disease and Total Mortality Rates by Age and Sex, 1951 and 1961 (Rates per 1,000 persons)

7.2 England and Wales Coronary Heart Disease and Total Mortality Rates by Age and Sex, 1931-1961 (Rates per 1,000 persons)

8.1 United States Percentages of All Deaths Caused by Coronary Heart Disease, 1940-2010*

8.2 United States Ischemic Heart Disease and Total Mortality Rates by Age, Sex, and Race, 1970-2010 (Rates per 1,000 persons)

8.3 United States Ischemic Heart Disease Mortality Rates, Ages 65 and Over, 2000-2014 (Rates per 1,000 persons)

10.1 United States Coronary Heart Disease and Total Mortality Rates: State Averages and Standard Deviations, 1950-90 (48 state average age adjusted rates per 1,000 persons)

11.1 Canada Ischemic Heart Disease Mortality Rates by Age and Sex, 1970-1999 (Rates per 1,000 persons)

11.2 England and Wales Ischemic Heart Disease and Total Mortality Rates by Age and Sex, 1971-91 (Rates per 1,000 persons)

11.3 Western European Countries Ischemic Heart Disease Mortality Rates by Sex, 1970-2000

11.4 Western European Countries Total Mortality Rates by Sex, 1970-2000 (Age adjusted rates per 1,000 persons)

11.5 Arteriosclerotic and Degenerative Heart Disease Mortality Rates by Age and Sex, Selected Countries, 1960 (Rates per 1,000 persons)

12.1 United States Ischemic Heart Disease Mortality by Sex, Age, and Race, 1970 and 2010

The purely epistemological question “How do we know” often diverts attention from more fundamental and (and ultimately political) questions such as: Why do we know this and not that? Why are our interests here and not there? Who gains from knowledge of this and not that?

Robert N. Proctor, Value-Free Science? Purity and Power in Modern Knowledge (Cambridge, MA: Harvard University Press, 1991), p. 10.

Dedicated to
the medical historians of previous generations
who inspired many of us with their collegiality
and commitment to the highest standards of scholarship.

Introduction

Readers who seek a brief summary of the findings, conclusions, and recommendations of this study can read Chapter 12. Chapter 12 does not describe the concepts and methods used in the research, the data used in the analyses, or the nature and scope of the findings.

This study demonstrates that a pandemic of coronary heart disease emerged and declined in most advanced countries in the world during the last two-thirds of the twentieth century. The substantial differences between pandemic coronary heart disease and the disease before and after the pandemic demonstrate that novel causal factors produced the pandemic. The similar characteristics and timings of the pandemic disease in all affected countries demonstrate that it was the result of a single set of causal factors that occurred in all locations at the same times.

Pandemic coronary heart disease differed strikingly from the coronary heart disease early in the twentieth century, which was an uncommon health problem of the elderly. The pandemic emerged in the 1930s and 1940s with rapid increases in adult mortality rates in many advanced countries. Mortality rates increased by much greater amounts for men than women and for older than younger age groups of both sexes in every affected country. The pandemic of this novel form of coronary heart disease reached a peak about mid-century and became a leading cause of death among adults in all affected countries. The peak period ended in the 1970s, after which mortality rates decreased steadily and substantially. The decreases in mortality rates were greater for men than women and for older than younger age groups, which demonstrated that their high mortality rates were caused by the pandemic disease.

Coronary heart disease is a partial or total blockage in the arteries that provide blood to the heart muscle. Lack of an adequate blood supply can produce severe pain, permanently damage the heart muscle, and cause a number of diseases, disability, and death. Early in the twentieth century it was an uncommon disease of the old that was thought to be one of several consequences of “hardening of the arteries.” Mortality rates began to increase steadily in the 1930s, notably among persons much too young to experience hardening of the arteries. By midcentury it became the leading cause of adult deaths in many advanced countries on three continents and aroused great concern.

Experts decided that the great increases in coronary heart disease mortality rates in advanced countries were caused primarily by recent dietary and lifestyle changes that resulted from improvements in their standards of living. High rates of the disease would continue indefinitely unless the diets and lifestyles were modified. The experts developed public health programs to implement this theory. They emphasized reduced consumption of types of foods that they believed contributed to the blockages of arteries. They identified high blood pressure and high levels of blood cholesterol as risk factors for the disease. Drugs were developed that decreased levels of these risk factors.

In the 1970s, the high coronary heart disease mortality rates that experts had expected to continue for the foreseeable future began a steady, substantial, and prolonged decrease. The decreases in mortality rates were reversals of the patterns that occurred during the emergence of the pandemic. The decreases occurred at about the same times in all countries, as had the increases. The population groups that experienced the greatest increases in mortality rates during the rise of the pandemic experienced the greatest decreases in mortality rates during its decline. The geographic regions that experienced the greatest increases in mortality rates during the rise of the pandemic experienced the greatest decreases in mortality rates during its decline.

The increases and decreases in coronary heart disease mortality rates in many advanced countries at the same times render it inconceivable that dietary and lifestyle changes were responsible for the pandemic. The advanced countries on three continents that experienced the pandemic are diverse in their economies, cultures, geographies, and social structures. It is beyond the realm of possibility that every one of these countries experienced the same changes in diets and lifestyles at the same times to cause the emergence of the pandemic and then experienced reversals of the changes at the same times to cause ...

Table of contents

• Cover
• Halftitle
• Title Page
• Copyright Page
• Table of Contents