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Coronary heart disease (CHD)--one or several diseases? Changes in the prevalence and features of CHD
Maria Inês Azambuja1, Richard Levins
1Graduate Program of Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. miazambuja@terra.com.br
Insights
Coronary heart disease (CHD) mortality followed an epidemic pattern in the 20th century. Researchers propose distinct hypercholesterolemia and insulin resistance subgroups, with historical events potentially influencing chronic disease susceptibility.
Area of Science:
- Cardiovascular epidemiology
- Immunology
- Historical epidemiology
Background:
- 20th-century coronary heart disease (CHD) mortality exhibited an epidemic curve, rising until the 1960s and then declining.
- CHD has been viewed as a singular condition with multiple causes.
- This study posits that CHD may consist of at least two distinct patient groups: those with hypercholesterolemia and those with insulin resistance.
Observation:
- The 20th-century CHD epidemic was primarily driven by shifts in the hypercholesterolemia subgroup's incidence.
- A hypothesis suggests that individuals who survived the 1918 influenza pandemic became susceptible to lipid-related CHD and coronary thrombosis upon subsequent influenza infections.
- This vulnerability might stem from autoimmune interference with low-density lipoprotein-receptor interactions.
Findings:
- CHD may not be a single entity but comprises distinct subgroups linked to hypercholesterolemia and insulin resistance.
- Historical events, such as the 1918 influenza pandemic, may have long-term impacts on population susceptibility to chronic diseases like CHD.
- Individual life experiences could influence susceptibility to both infectious and chronic diseases.
Implications:
- Understanding distinct CHD subgroups can refine etiological models and therapeutic strategies.
- Investigating the link between historical pandemics and chronic disease epidemics offers new perspectives on public health.
- Recognizing the influence of life experiences on disease susceptibility may lead to personalized prevention approaches.
Abstract:
In retrospect, mortality from coronary heart disease (CHD) in the 20th century followed an epidemic pattern: mortality rates increased dramatically from 1920 until about 1960, remained roughly constant for almost a decade, and have been decreasing since the late 1960s. CHD has traditionally been conceived of as a single disease with multifactorial causality. We suggest instead that CHD cases may comprise at least two distinct populations: those associated with hypercholesterolemia, and those associated with insulin resistance. The epidemic of CHD was due primarily to changes in the incidence of the hypercholesterolemia subgroup. We propose that young adults who survived the 1918 influenza pandemic were rendered vulnerable to lipid-associated CHD and coronary thrombosis upon reinfection with influenza later in life. This vulnerability may be due to autoimmune disruption of low-density lipoprotein-receptor interactions. Historical events may affect the health of populations by affecting the susceptibility of populations to chronic diseases such as CHD. The life experiences of individuals are known to influence their susceptibility to infectious diseases; we suggest that life experiences may also influence individual susceptibility to chronic diseases.
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