Thesis ID: CBB114540913

Explaining the Decline of Coronary Heart Disease Mortality in the United States in the 1960s: an Historical Analysis (2015)


Coronary heart disease (CHD) as a chronic disease came to attention in the United States and other countries in the early 20 th century. Over the course of the 20th century its incidence rose to epidemic proportions and it became the leading cause of death in this country as well as most industrialized nations. Prevention and treatment of the disease evolved over the century and mortality plateaued in the U.S. in the 1960s and by all accounts began to decline by the end of the decade. The reason for the decline has been speculated and investigated since the 1970s, when it was first fully recognized, but has never been adequately explained. This dissertation takes a critical look at CHD and its evolution as a disease and major cause of death over the course of the twentieth century. More pointedly it attempts to explain the reason or reasons for the abrupt initial decline in its mortality which began in 1968 and has continued to date. As a result of archival research and oral histories, as well as statistical analysis, it is clear that there is no one single explanation for the initial decline in disease mortality. After 1974 it appears that both prevention and treatment played important roles in reducing the mortality of CHD but the initial decline in 1968 appears to have been the result of a number of factors, the least of which seems to be prevention. By the data amassed in this dissertation it is unlikely that mitigation of what are considered the major risk factors for CHD, including elevated serum cholesterol, hypertension and smoking, resulted in an initial reduction in mortality. Much more likely it was a number of incremental changes that occurred in the treatment of the disease, including the cardiac chair (an end to prolonged bed rest as treatment), the advent of the coronary care unit, the professionalization of the specialty of cardiology, Medicare and Medicaid that together led to a reduction in CHD mortality.

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Authors & Contributors
Jones, David S.
Sabino Illecito
Binney, Nicholas
Silberstein, Marc
Lambert, Gérard
Danesh-Pajouh, Mohammad
Social History of Medicine
Tarikh-e Elm (The Iranian Journal for the History of Science)
Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences
Revue d'Histoire des Sciences
Medical History
Isis: International Review Devoted to the History of Science and Its Cultural Influences
University of Chicago Press
The Foundation for Advances in Medicine and Science, Inc.
L'Erma di Bretschneider
Johns Hopkins University Press
Disease and diseases
Cardiovascular disease
al-Rāzī, Abū Bakr Muḥammad ibn Zakariyyā
Ibn al-Nafis
al-Majusi, ‘Ali ibn al-'Abbas
Time Periods
20th century
19th century
21st century
16th century
20th century, late
Indian Ocean
United States
Great Britain
American College of Cardiology
United States. Food and Drug Administration

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