(Circulation. 2001;103:2428.)
© 2001 American Heart Association, Inc.
Special Report |
Coronary Heart Disease in the First 30 Years of the 21st Century: Challenges and Opportunities
The 33rd Annual James B. Herrick Lecture of the Council on Clinical Cardiology of the American Heart Association
Presented at the Annual Meeting of the American Heart Association’s Council on Clinical Cardiology, New Orleans, La, November 14, 2000.
From the Cardiovascular Division, Department of Internal Medicine, University of Virginia Health System, Charlottesville, Va.
Key Words: coronary disease • diabetes mellitus • myocardial infarction • obesity
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Introduction |
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During the past 50 years, there has been an explosion of new knowledge regarding the biological mechanisms of cardiovascular disease. This knowledge and the emergence of new technology and new pharmacological, interventional, and surgical therapies, coupled with lifestyle changes in the American population, have contributed to a spectacular 60% decline in mortality from coronary heart disease (CHD) and stroke.1 Since 1965, there has been a dramatic and steady decline in CHD deaths. This marked decrease in the mortality rate for CHD can be attributed in part to enhanced survival in patients with an acute myocardial infarction (MI); highly effective secondary prevention measures in patients who have experienced an ischemic event; improved lifestyles in the population, with some progress in primary prevention of CHD; and advances in medical therapy and the emergence of coronary revascularization. With respect to the decline in CHD mortality from 1980 to 1990, 25% can be explained by primary prevention, 29% by secondary prevention, and 72% by the improvements in medical therapy and revascularization; only 3% is unexplained.2
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Improved Prognosis After Acute MI |
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Figure 1
depicts a significant decrease in the death rate
and case fatality rate for acute MI among persons 45 to 64 years of age
in the United States from 1970 through
1995.3 In Osler’s
Textbook of Medicine published
in 1892,4 only 2 pages were
dedicated to a discussion of acute MI. This foremost educator of his
era wrote, "A complete obliteration of one coronary artery,
if produced suddenly, is usually
fatal."4 It was James B.
Herrick (born in This article has been cited by other articles:
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