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The hypothetical epidemic of coronary heart disease and atherosclerosis
1Department of Pathology, Wellington School of Medicine, New Zealand.
Insights
The term "epidemic" should strictly refer to contagious diseases, not non-infectious conditions like coronary heart disease. Using "epidemic" for coronary heart disease lacks scientific basis and hinders research into actual causes.
Area of Science:
- Epidemiology
- Cardiovascular Medicine
- Medical Terminology
Background:
- The term 'epidemic' is often misused for non-infectious diseases, including coronary heart disease (CHD).
- CHD is a complex condition, a complication of various diseases, not a singular entity susceptible to epidemic classification.
- Atherosclerosis, a key component of CHD, is ubiquitous, making an 'epidemic' of it scientifically impossible.
Purpose of the Study:
- To clarify the accurate scientific definition and application of the term 'epidemic'.
- To challenge the notion of a coronary heart disease epidemic and its implications.
- To advocate for precise terminology in medical and scientific discourse.
Main Methods:
- Critical analysis of the definition and application of 'epidemic' in scientific literature.
- Evaluation of the epidemiological characteristics of coronary heart disease and atherosclerosis.
- Review of vital statistics and mortality trends related to CHD, stroke, and all-cause mortality.
Main Results:
- The term 'epidemic' is inappropriately applied to non-infectious diseases like CHD.
- An 'epidemic of atherosclerosis' is impossible due to its universal prevalence.
- Vital statistics are insufficient to reliably confirm CHD epidemic trends; alleged increases are inconsistent with other mortality data.
Conclusions:
- The concept of a coronary heart disease epidemic lacks scientific validity.
- Misuse of 'epidemic' for CHD obscures understanding and misdirects research efforts.
- Accurate terminology is crucial for scientific integrity and effective public health strategies.
Abstract:
Accurate usage of the term 'epidemic' is important scientifically and it should ideally be used to mean only contagious diseases, not used loosely or emotively to mean non-infectious diseases, particularly coronary heart disease, which is a non-specific complication of many diseases. It should not be used as a surrogate term for atherosclerosis of indefinite severity. An epidemic of atherosclerosis is impossible, there being no variation in prevalence because the disease is ubiquitous. Moreover, vital statistics are too unreliable to determine the existence of an increase or decline in coronary heart disease. A coronary heart disease epidemic could be due to an increase in non-atherosclerotic coronary heart disease or increased severity of atherosclerosis. The former has not been studied and the latter would cause a shift to the left in age distribution and is inconsistent with the fall in 'all cause' and stroke mortality rates whilst coronary heart disease mortality allegedly increased alarmingly. A coronary heart disease epidemic, having no scientific basis, negates any reason for the sustained search for a speculative causative environmental factor.