THE DEATH rate from coronary heart disease suddenly started a sharp decline in 1964 after rising steadily for several decades.1 The onset of this decline in the leading cause of death in the United States coincided precisely with the Surgeon General's report on smoking and health in January 1964.2 The decline is among the most dramatic reversals of a mortality trend in our nation's history. From 1950 to 1963, the age-adjusted death rate from coronary heart disease increased 19%. From 1963 to 1971 it fell 10.5%. The most striking reduction has occurred in the most productive years of life—25 to 74 years (Table).
According to the National Center for Health Statistics, the decline is continuing. During each of the past four years, we have had the highest life expectancy ever attained in the United States, despite increased death rates from cancer, diabetes, bronchitis, emphysema and asthma, cirrhosis of