Imprecision of the clinical diagnosis of coronary heart disease in epidemiological studies and atherogenesis.

Coronary heart disease (CHD) is an imprecise diagnosis associated with a substantial diagnostic error and provides an erroneous assessment of the morbidity and mortality of myocardial ischemia and of severe coronary atherosclerosis. Due to the inability to measure the severity of atherosclerosis during life, epidemiologists frequently use the incidence of CHD as a surrogate monitor of severe atherosclerosis. It is therefore important in clinical epidemiological studies to appreciate the degree of inaccuracy of CHD statistics, which detracts from the value of such studies and their reliability.