For an adequate understanding of the problem of cardiovascular diseases in the United States today, it is valuable to review the evolution of the health picture during the last 50 to 100 years. This has been a period of remarkahle advance, probably unparalleled in any previous era of human history. Progress has tjeen particularly great in lengthening the expectation of life at birth (Fig. 1 and 2, Tables I--IIIt).r-8 For all persons, life expectancy at birth has increased more than 20 years, from ahout 48 years in 1900 to about 69 years in 1959. For white males the increase has been 19.1 years (39.6 per cent), from 48.2 to 67.3 years, since the turn of the century; for white females it has increased by 22.8 years (44.6 per cent), from 51.1 to 73.9 years. Longevity of the nonwhite (chiefly Negro) population has also improved greatly during the twentieth century; the difference between whites and nonwhites in average length of life has decreased considerably, to 6.4 years for males and 7.7 years for females (Table I). This phenomenal advance in life expectancy is attributable first of all to the conquest of infectious diseases, particularly acute infectious diseases in young children, which previously took a heavy toll (Fig. 1 and 2, Tahle III).~-~ In 1901 less than 80 per cent of newborn infants in the United States could he expected to survive t Tables noted throughout paper will appear in author’s reprints. to their fifth birthday. The corresponding figure for 1959 was almost 97 per cent. In 1901 a little over 75 per cent of newborn infants could be expected to reach their fifteenth birthday; the figure for 1959 was over 96 per cent. Appreciable decreases in mortality among middle-aged and older people also have occurred during recent decades, largely as a result of advances in the control of infectious diseases, particularly pneumonia and tuberculosis (Fig. 1 and 2, Tables I and IV). A major consequence of these developments has been a marked increase in the number of middle-aged and elderly persons in the United States. By 1960 there were almost 17 million persons aged 65 and over-more than five times as many as in 1900. In the same period the number of middle-aged persons (45-64) increased from 10 million to 36 million. Persons 65 and over and those 45 to 64 constituted 4 per cent and 14 per cent, respectively, of the total population in 1900; by 1960 these percentages had increased to 9 per cent and 20 per cent9 Howeuer, for the incwusing millions of middleaged and elderly persons, the outlook for life rxpctancy today is only moderately better than it was at the turn of the century. The death rates for persons aged 45 to 64 and those 65 and over have declined much less than death rates for children and young adults (Fig. 2). Therefore, for white males and females aged 40, life expectancy has increased only 3.8 and 4.7 years, respectively, since 1900-l 902 ; for nonwhites, the corresponding figures are only 4.7 and 6.9 years (Table I). The situation is similar at age 60. Males have generally done less well than females, white males the least well. The fundamental reason for this is the slow progress against the cardiovascular diseases (Fig. l-3 and Table IV). In fact, for middleaged males, particularly white males, the