Falling Coronary Heart Disease Rates

The coronary heart disease (CHD) epidemic peaked in the 1960s. Since that time age-adjusted mortality declined steadily in the United States and many other industrialized countries(1). Hospitalization for CHD also fell, particularly in the past two decades with CHD severity decreasing as NSTEMIs increased, indicating milder forms of CHD(1). Finally, lifestyle factors and associated risk factors improved such as smoking, hypertension and cholesterol(1). These changes and the trends over time lead naturally to the question of causality. Are changes in lifestyles, risk factors, or acute and chronic clinical care playing roles in this evolving picture and how does each influence the desired outcomes? In this issue of Circulation, the paper by Mannsverk and colleagues(2) in Norway provides insights into the evolving cardiovascular disease epidemic.