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40
Besides being responsible for a prodigious loss of man-working
capacity in the United Kingdom amounting, it is estimated, to some
12 million week days per year, cardiovascular and atherosclerotic
diseases as a group are responsible for more deaths than any other
single cause and, as such, constitute the greatest possible challenge
to preventive medicine. The urgency of this problem becomes intensified
when it is realised that deaths from arteriosclerotic and
degenerative heart disease are mounting year by year particularly
in the case of middle-aged males.
As a group, the middle-aged man is enjoying unprecedented
prosperity and affluence but not the standard of health of prewar
days. Heart disability, with particular emphasis on coronary
disease, is the main cause of death in these men and approximately
⅔rds of all heart deaths in males occur during this middle
period of their lives. The persistently rising death rate of this
group and the consequent loss to the nation of such potential
is cause for great concern.
Information has been given in previous reports relating to the
aetiological factors which, in the light of present day knowledge
are thought to be implicated, namely: excess of animal fat in the
diet producing a rise in serum cholesterol—the association of smoking
with heart disease—the lack of physical activity and coronary
disease and its hypothetical connection with "stress and strain."
Dietary fat is considered to be a cause of coronary atheroma
for two very good reasons:—
1. In communities where the habitual diet is low in
animal fat, coronorary disease has a low incidence rate.
For example, in Southern Italy where the peasants' diet
consists mainly of pasta, fish, fruit and vegetables, and where
the intake of fat is predominantly vegetable in origin (olive
oil), coronary disease is rare.
Again, this disease was not common in poor, undernourished
Arab-Jews arriving in Israel during 1948, whose
diet until then had been low in animal fat. Within ten
years of living on a westernised regimen this disease began
to make its appearance.
2. In the affected arteries, fat-like substances are found
in the atheromatous areas.
The lipids in these atheromatous patches are in fact
normal constituents of the blood, and cholesterol is the fat
present in greatest quantity. Blood cholesterol varies not
only from person to person but also from time to time in
the same person, even in health. Nevertheless, coronary
disease is found more often in patients where the level of
the blood cholesterol is relatively raised.