Trends in CHD in the United States.

Coronary heart disease (CHD) death rates increased in the United States until the mid 1960s then declined. Declines were greater for acute myocardial infarction (AMI), for younger age groups, for the white population, and for higher socioeconomic groups. Trends in incidence are uncertain but in-hospital fatality rates have decreased. There have been major advances in diagnosis, prevention and treatment of CHD, and numbers of internists and cardiologists, emergency medical services, and coronary care units have increased. New potent medical and surgical treatments for acute and chronic CHD have been introduced. Reductions in risk factors include decreases in cigarette smoking especially among men, falls in mean systolic blood pressure, rises in the proportion of hypertensive adults who are treated and controlled, and reductions in plasma cholesterol. Consumption of whole milk, butter, and eggs decreased whereas use of low fat milk, cooking oils, poultry, fish, vegetables, and fruits increased. However, the prevalence of obesity has increased. CHD is still the leading cause of death, and its prevalence is expected to rise as the population increases at older ages and treatment prolongs survival of patients with CHD.