The changing pattern of ischemic heart disease
Insights
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).
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.
Abstract:
Male and female death rates from all the major forms of cardiovascular disease were approximately equal until about 1920. Since that time the male:female ratio in fatal ischemic heart disease (IHD) has risen dramatically, but some closely related diseases such as cerebrovascular disease and uncomplicated angina pectoris have maintained sex ratios close to unity. It is difficult to reconcile this divergent trend in the sex ratio of IHD with a simple stenotic-thrombotic view of myocardial infarction (MI) and it is suggested that the modern epidemic of MI in men may be the result of a disorder of muscle metabolism ("vulnerable myocardium") superimposed on a relatively stable background of stenotic-thrombotic arterial disease. The proposed mechanism would also help to explain the selective action of some modern "coronary risk factors" (such as cigarette smoking and physical inactivity) which increase the risk of MI but have little or no effect on the risk of developing cerebrovascular disease or uncomplicated angina pectoris.
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