THE RECENT decline in deaths from coronary heart disease (CHD) and accelerated decline in cardiovascular mortality in general since 1968 have elicited great interest and speculation as to their cause.1 The improvement has been attributed to possible impacts of medical advances, preventive measures, and changes in life-style. One unequivocal conclusion is that these diseases are not an inevitable consequence of aging or genetic makeup and can be prevented.
Since the mid-1960s, there has been a substantial decline in mortality from cardiovascular disease. Age-adjusted cardiovascular death rates in the United States fell 25% in the decade ending in 1979, and the decline seems to be continuing through the present. This decline in cardiovascular mortality has also occurred in Canada and in some, but not all, of the industrialized countries of western Europe.2
While the trend in cardiovascular mortality is encouraging, these diseases continue to rank first among the leading