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The changing pattern of ischemic heart disease.

T W Anderson

    Canadian Medical Association Journal
    |June 23, 1973
    PubMed
    Summary

    Male death rates from ischemic heart disease (IHD) have risen disproportionately since 1920. A metabolic disorder, "vulnerable myocardium," may explain this trend and the impact of certain risk factors on myocardial infarction (MI).

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    Area of Science:

    • Cardiovascular Disease Epidemiology
    • Metabolic Cardiology

    Background:

    • Historically, male and female cardiovascular disease death rates were similar.
    • Since 1920, a significant divergence in sex ratios for fatal ischemic heart disease (IHD) has emerged, while other conditions like cerebrovascular disease remain near unity.
    • This trend challenges simple explanations for myocardial infarction (MI).

    Purpose of the Study:

    • To investigate the divergent trends in sex ratios for cardiovascular diseases.
    • To propose a novel mechanism for the modern epidemic of myocardial infarction (MI) in men.
    • To explain the selective impact of certain risk factors on MI versus other cardiovascular conditions.

    Main Methods:

    • Comparative analysis of historical epidemiological data on cardiovascular disease mortality by sex.
    • Theoretical modeling of disease mechanisms.
    • Review of established coronary risk factors and their differential effects.

    Main Results:

    • Fatal ischemic heart disease (IHD) shows a dramatically increasing male:female ratio since 1920.
    • Cerebrovascular disease and uncomplicated angina pectoris maintain near-unity sex ratios.
    • Modern risk factors like smoking and inactivity disproportionately affect MI risk compared to cerebrovascular disease or angina.

    Conclusions:

    • A simple stenotic-thrombotic arterial disease model cannot fully explain the observed sex ratio trends in IHD.
    • A "vulnerable myocardium" hypothesis, involving a muscle metabolism disorder, is proposed to explain the male epidemic of MI.
    • This metabolic hypothesis accounts for the selective influence of certain modern risk factors on MI development.

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