Q J Med 2001; 94: 107-112
© 2001 Association of Physicians
Commentary |
With increasing ageing in Western populations, what are the prospects for lowering the incidence of coronary heart disease?
From the Human Biochemistry Research Unit, Department of Tropical Diseases, School of Pathology of the University of the Witwatersrand, and the South African Institute for Medical Research, Johannesburg, South Africa
Coronary heart disease (CHD), rare in the early 1900s, in the 1970s was responsible for almost a third of deaths in Western populations. Although its mortality rate has fallen in the last 20 years, considerably in certain populations, it remains the leading cause of death, and there is little evidence of any fall in its incidence rate. The primary risk factors, which include pattern of diet, smoking practice, and level of physical activity, are well known, but explain only 
50% of variation in its occurrence. Despite the numerous health improvement recommendations made, alterations in diet have been relatively slight. Although smoking practice has halved in some populations, its prevalence is now rising in the young. The extent of physical activity is low, compared with that in the past, and may even be decreasing in the young. With the general ageing of populations, the near absence of strong encouragement from the state, and individuals' general failure to reduce risk factors significantly, the chances of decreases in the incidence of CHD appear remote.
Address correspondence to Dr A.R.P. Walker, Human Biochemistry Research Unit, South African Institute for Medical Research, PO Box 1038, Johannesburg, 2000, South Africa. email: alexw{at}mail.saimr.wits.ac.za