Invited Commentary: Heterogeneity of Cardiovascular Diseases Among Populations—Recognition and Seminal Explanations

Kuller and Reisler's 1971 publication (Am J Epidemiol. 1971;93(1):1-9) was an important contribution to the understanding of the epidemiology of cardiovascular diseases, particularly stroke. The authors synthesized pathological and risk-factor evidence to theorize why rates of various subtypes of arterial disease might vary across populations. Specifically, they suggested that different population levels of blood pressure, lipids, and glucose led to population differences in the location and extent of arterial disease. The publication is an excellent model of how to integrate data on person, place, and time of a major public health problem, together with information on pathology and factors that determine individual risk, to derive a coherent explanation for population patterns in cardiovascular disease. The authors' basic theory has proven solid for the past 5 decades.