Today or in the past? The origins of ischaemic heart disease.

Recent studies have suggested that regional differences in death rates from ischaemic heart disease (IHD) may result from exposure to poverty in foetal and early infant life. The suggestion is that such influences 'permanently set structures and metabolic processes, so-called programming'. On this theory, current falls in IHD death rates reflect much earlier reductions in poverty. If the theory were correct, the fall in rates would begin with younger age groups and be reinforced only at the pace at which each new birth cohort reached adult life. There is no evidence of such a cohort effect. Rates fell simultaneously over a very brief period in each country and region examined. The results are more compatible with theories involving contemporary lifestyle changes.