Coronary Heart Disease Rates
among Adventists and Others
Deaths from coronary heart disease have decreased by half or more in the United States over the last 30 years (Gillum, 1993; Havlik and Feinleib, 1979). Despite this, it is still a major killer in the United States and most Western countries, as well as being leading cause of morbidity. Among the manifestations of this disease are myocardial infarction (heart attack), sudden death, congestive heart failure, serious arrhythmia, and angina pectoris.
Coronary heart disease (CHD) is a consequence of the atherosclerotic process as it affects the coronary arteries and thus diminishes the blood and oxygen supply to the heart muscle. Atherosclerosis is an accumulation of cholesterol, cholesterol esters, collagen, and inflammatory cells beneath the lining of arteries (Ross, 1993). We now understand that this process depends on higher values of LDL cholesterol and a relatively oxidizing environment (Witztum, 1994). The oxidized LDL cholesterol filters into the artery wall and tends to remain there, forming a plaque that may protrude into the open space (lumen) of the artery.
The cholesterol deposits provoke an inflammatory response that may weaken the integrity of this fatty mass, allowing it to rupture into the bloodstream. Then a clot, or thrombus, often forms at this site and completely closes the artery, resulting in the death of a portion of the heart muscle supplied by that artery—a myocardial infarction. The disorganization of electrical activity in the heart produced either by the scar from a heart attack or by the decreased supply of oxygen to the surviving heart muscle may provoke serious arrhythmia or even sudden death.
Lifestyle choices, particularly dietary habits and cigarette smoking, can alter this cascade of events at several points by changing the levels of blood cholesterol (Criqui et al., 1980; Jacobs et al., 1979); the oxidation state of the blood (Gilligan et al., 1994; Morrow et al., 1995); and the likelihood