The epidemiology of coronary heart disease: a review

The contribution of epidemiology to the understanding of coronary heart disease (CHD) is described. (1) Descriptive epidemiology has shown the main differences between human populations and the strong association existing between the frequency of the disease and the parameters attesting their levels of socio-economic development. (2) Etiological research has identified the risk factors presumably playing a causal role; it also allows a multifactorial evaluation of risk. A pathogenetic hypothesis has been suggested which proposes a sequence of etiological relationships between the saturated fat content of the diet, the level of serum cholesterol and the development of the disease (Diet Heart Hypothesis). (3) Preventive trials have almost confirmed this hypothesis. The decrease of cholesterol level obtained by diet or drug treatment lowers the risk of the disease, the reduction of the cigarette consumption bringing an additional effect. It has not yet been possible to prove the benefit of an antihypertensive treatment towards the risk of CHD.