Coronary Heart Disease, Diet, and Western Mortality

Abstract

RAPID DECLINE OF INFECTIOUS AILMENTS and the rise coronary heart disease (CHD) as the leading cause adult mortality can be traced in every Western country since the beginning this century.' Although during the past generation the total rates cardiovascular mortality have been declining in most European countries, as well as in North America and Australia, CHD still claims every year more lives than all cancers combined.2 For middle-aged and older men myocardial infarction (the death heart-muscle tissue) remains the leading cause death-or becoming seriously incapacitated while awaiting the return the dreaded episode. The cost CHD is enormous: Weinstein (1985) estimated that in the United States the overall annual burden coronary mortality and morbidity exceeds $100 billion; direct health care expenditures and lost productivity have been put at $49 billion (US Department Health and Human Services, 1988). The combination this huge economic loss and extensive individual and family suffering-in the United States there are about 1.25 million heart attacks each year (two-thirds among men) and roughly every fourth death is due to CHD-has been a powerful incentive for intensive research into the etiology and prevention the disease. Two generations epidemiological studies have identified a large group personal and environmental factors implicated in the etiology the disease, and diet, especially the intake saturated fat and cholesterol in meat, eggs, and dairy products, has come to be seen as highly important, if not the decisive ingredient in the obviously multifactor disease process.3 William Castelli (1984), Medical Director the Framingham Heart Disease Epidemiological Study, wrote that of all the known risk factors for coronary heart disease, high cholesterol is probably the most decisive-and it seems logical to link high blood cholesterol levels with particular diets. There is no doubt