Although there were case reports in the early years of the 20th century, the onset of the epidemic was in about 1924 with an exponential increase leading to a peak in 1970. The emergence of the epidemic was described clearly by Dr Maurice Campbell of Guys Hospital. He was one of the leading cardiologists in the UK in the post-war years and he was respected for his careful data collection and interpretation.
There became a major public health problem. There had been important heart diseases before the emergence of the CHD epidemic - rheumatic heart disease (following rheumatic fever earlier in life), syphilitic heart disease (usually following sexual indiscretion earlier in life), and endocarditis, an infection of heart valves usually complicating rheumatic heart disease. But rather than total heart disease deaths diminishing, the total increased as a result of the new widespread disease of the coronary arteries.
At the peak of the epidemic in 1970 there were 520 deaths per 100,000 per year in England and Wales, 700 in the USA, and an astounding 960 in men in the West of Scotland, the world's highest incidence. Thereafter there was an abrupt and apparently spontaneous decline, by 83% during the next 20 years to 1990. This is an important observation as during this time there was no widespread effective medical intervention. As the epidemic occurred in all continents simultaneously (with the exception of the tropics) it should be regarded as a pandemic.
The decline continues. At present the death rate is about 20 per 100,000 per year and the decline appears to continue. As a result of the rapid decline of CHD deaths, average life expectancy has increased and we now experience a rapid increase in the number of elderly.
We appear to have experienced a natural epidemic and it is now almost over. The cause of it has not been obvious, but when we realise that CHD has been an epidemic we can start to think objectively about what might have caused it.
FOR MORE BLOG POSTS SEE:
The 20th century epidemic of Coronary Heart Disease - report from the USA
The decline of deaths from Coronary Heart Disease
The population without pestilence - life after the epidemic of Coronary Heart Disease
The epidemic of CHD - the peak in 1970
Coronary Heart Disease - the onset of the epidemic
Coronary heart disease - yesterday, today, and tomorrow
The cause of Coronary Heart Disease
For more detail see eBook "You will not die from a heart attack", Medical Briefs series £0.99
Maurice Campbell: first editor of Heart. Silverman ME. Heart. 2003 Dec;89(12):1379-81.
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UK Department of Health. The National Service Framework for Coronary Heart Disease: Winning the War on Heart Disease. The Stationary Office: London 2004.
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Grimes DS eBook – You will not die from a heart attack.