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Changing Life-styles and Ischemic Heart Disease

Samuel Vaisrub, MD
JAMA. 1980;244(7):700. doi:10.1001/jama.1980.03310070050033.
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Coronary heart disease was either rare or unrecognized as such in previous centuries. Its recognition and meteoric rise in the 20th century is something of a mystery. Enormous investigative effort has gone into identifying risk factors for this disease. Hypertension, cigarette smoking, cholesterol-rich foods, lack of exercise, and type A personality—all have been indicted with varying degrees of confidence. Their reduction or, whenever possible, elimination by modifying "life-styles" has become the target of public education.

Have these endeavors been successful in modifying menacing life-styles, and, if so, have they made a substantial dent in the incidence of ischemic heart disease?

It is easier to answer the first question than the second. Although individual compliance has to be taken on faith, one can hardly ignore the reported1 substantial decline in the United States in per capita consumption of cigarettes, dairy products, eggs, and animal fats and the rise in consumption of


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