For some doctors in affluent countries the first question about prevention of coronary heart disease (CHD) nowadays is whether to write a prescription for one of the statins (simvastatin, pravastatin, flu vastatin, atorvastatin, etc) which inhibit an early step of cholesterol biosynthesis in the body (see p 7).
Tables are available to show whether the 5- or 10-year risk justifies the cost of long term statin medication, but the relation of diet and CHD is still of primary importance for the majority of people.
What we eat is bound up with the aetiologia of CHD. Many people do not know their current plasma cholesterol, many coronary deaths occur before medical help and most countries cannot afford these expensive drugs.
Coronary heart disease is the largest single cause of death in Britain and the disease that causes most premature deaths, but it is only one-seventh as common in industrial Japan and rare in the masses in most developing countries.
Its incidence must be environmentally determined because immigrant groups soon take on the incidence rate of their new country and there have been large changes in mortality over time.
Coronary heart disease was uncommon everywhere before 1925 and then increased steadily in Western countries until the 1970s, except for a dip during the Second World War.
