Coronary heart disease (CHD) remains the number 1 cause of death in the United States today; however, the mortality rate for CHD has declined steadily in this country for the last 15 years.1,2 Considerable attention is being focused on this declining fatality rate and major efforts are being made to understand the many factors contributing to it. Most commonly cited as responsible for the decline in CHD deaths are those factors associated with primary prevention of atherosclerosis, ie, changes in the American diet, decreased per capita consumption of cigarettes, extensive diagnosis and treatment of hypertension and increased levels of exercise.1,2 Also implicated are factors associated with secondary prevention of CHD mortality, namely, medical and surgical therapy of angina pectoris and myocardial infarction. Positive effects from both primary and secondary preventive interventions have been identified in animal studies and epidemiologic surveys.
Of particular interest are recent reports of a
Alpert JS. Cardiovascular Diseases. JAMA. 1985;254(16):2264–2267. doi:10.1001/jama.1985.03360160096020