An epidemic of coronary heart disease.
The major public health concern during the past 50 years has been coronary heart disease (CHD), which has been the leading cause of death in the UK and other nations in the temperate parts of the world, in particular northern Europe and North America. It has run in families and it has brought to a premature end the lives of people in their prime. It has robbed wives of their husbands and husbands of their wives. It has robbed children of their parents and sometimes parents of their children.

However, it is now clear that in these countries CHD was an epidemic of the latter half of the 20th century. The onset of the epidemic appears to have been shortly after the First World War, but now, in the early 21st century, the epidemic is almost at an end.

The earliest clinico-pathological report of CHD was in 1859, an anecdotal case report of myocardial infarction (MI) presented to the Swedish Medical Society.1 It defined the clinical features of MI and also the pathological features found at autopsy, linking the two aspects. The report was not known outside Sweden and at the time it did not appear to be important. The fact that this was a single case report was emphasized by the Swedish physician B.W. Johansson and pathologist P. Nichol. They drew attention to the 1859 report, contrasting it with 770 new cases of MI occurring in Malmo in 1978 alone.1

At the beginning of the 20th century, CHD was effectively unknown in the UK. It received no mention in the earlier writings of Sir James MacKenzie, who was initially a general medical practitioner in Burnley, Lancashire and later the father of cardiology in the UK.2 MacKenzie first mentioned angina in the third edition of his book …