The history of heart disease and its epidemiology is fairly new. It wasn't till the 1600's that William Harvey discovered and published the first accurate description of the human circulatory system. Harvey explained that blood flowed in one direction in the body and it was the lungs where venous blood and arterial blood was transformed. It was the heart, not the lungs, that moved blood throughout the body.
James Herrick delivered a speech to the Association of American Physicians in 1912 titled "Clinical Features of Sudden Obstruction of the Coronary Arteries". It was he who first coined the term "heart attack".
Cornelis De Langen, a Dutch doctor sent to Indonesia, reviewed 10 years of admission charts (over 70,000),"not a single case of thrombosis or embolism was seen". "Thrombosis and emboli, so serious in Europe, are most exceptional here".
http://www.epi.umn.edu/cvdepi/essay/cor ... eory-1916/
In his seminal early paper (published in Dutch), de Langen described clinical relationships among diet, serum cholesterol, and atherosclerosis: “. . . a cholesterol-rich diet and severe metabolic diseases, such as diabetes, obesity, nephritis, and arteriosclerosis, are associated with hypercholesterolemia” (de Langen 1916, 4).
He further connected blood lipids with diet in these early observations: “The question has frequently been asked whether cholesterol concentration of blood and bile is controlled by diet–the diet of the population in the Dutch East Indies differs very much from the Western European diet. The local diet is mainly vegetarian with rice as staple, that is very poor in cholesterol and other lipids” (ibid., 34).
Elsewhere, de Langen reported perhaps the first comment on exceedingly low blood cholesterol values seen in wasting diseases:
The food of the masses which visit our hospitals and polyclinics in Java contains but little cholesterin; the result is a smaller content of cholesterin in the blood. Especially in the very numerous patients with malaria and ancylostomiasis, the cholesterin content is quite often on the very low side. Whenever, in hospitals or elsewhere, we give people a diet rich in lipoids, the quantity of cholesterin in their blood rises at once. (Snapper 1963, 284)
Isadore Snapper:
As had de Langen in Java, Snapper soon observed the
rarity of Western diseases among the Chinese, with the
exception of a few successful merchants affected by diabetes
and atherosclerosis. And he was equally systematic if
more modern in his approach to documenting the cultural
contrasts, describing, for example, what he called an “epidemiologic
study” of electrocardiograms in the Peking Hospital:
“I studied all these electrocardiograms without looking
at the names and I found only a small number of
electrocardiograms typical for myocardial infarction. When
I had finished I . . . checked the names: all the coronary
disease electrocardiograms belonged to Occidentals who
had been admitted to the private pavilion! And among the
poor Chinese, I did not find any electrocardiographic curves
indicating coronary sclerosis, just as hardly any of our
Chinese patients had anginal complaints. The pathologist
[moreover] did not find arteriosclerosis at the autopsies of
our patients. Although the absence of arteriosclerosis in
Orientals has been found over and over again, there are still
doubting Thomases.”2
Snapper documented the vegetable nature of the northern
Chinese diet and its association with the rarity of CVD
cases, deriving details from Chinese studies that characterized
the average daily diet of the poor in China as consisting
of 2,100 cal, 88 g of protein, 47 g of fat, and 331 g of
carbohydrate.13 Snapper described the caloric sources: “As
far as the poor classes are concerned, the caloric energy of
their diet is almost entirely derived from cereals, that is,
yellow corn and millet.
Hugh Trowell sent to East Africa from Britain discovered only one case of a heart attack, a local, a judge, trained in England, that ate the Western diet. During his seven years in Nairobi, Trowell encountered only one case of diabetes, a nursemaid employed in a European home.
Denis Burkitt talks with Dr McDougall also about his time while in East Africa. Hugh Trowell and Denis Burkitt co-wrote "Refined Carbohydrate Foods and Disease". In the book one thing I found fascinating: the indigenous peoples had virtually no heart disease, diabetes, obesity, gallstones, diverticulosis, and hemorrhoids. But in Western society, not only might someone have one of these diseases, but one person could have more than one. It made me think of what we call "metabolic syndrome", which is a compilation of symptoms that are now quite common.
Nathan Pritikin explains very well in this talk with Dr McDougall how his epidemiological research led him to engage in a low-fat plant-based diet to cure his heart disease. In the video, he tells how all his doctors told him it wouldn't work and that he would suffer from malnutrition. It was scary for Nathan, but he trusted his own research over what respected medical doctors told him. Not only did Nathan reverse his heart disease, but when he died, he ordered that he be autopsied to check out his coronary arteries. His arteries were found to be that of a teenager.
From an LA Times article:
"What Hubbard found was a heart remarkably free of disease and coronary arteries that were completely open, without any hint of development of fatty plaques that plug up the vessels of heart disease victims and result in angina pain and often fatal heart attacks. While there were small traces of fatty tissue both in the heart muscle and in the coronary arteries, all four of the major arteries examined were totally free of any restriction--a condition virtually unheard of for a 69-year-old man living in a Western country."
Dr T Colin Campbell's "The China Study" is a book detailing the large observational study conducted in rural China.
Less than 100 years ago, the greatest cause of death were infectious diseases. Today, it's degenerative diseases. The #1 cause of death among heart surgeons is heart disease. And think about this: When these doctors (and Nathan Pritikin) were studying the epidemiological roots of this disease, for the most part, people back then (in Western nations) ate more whole foods. Today, it's estimated that over 90% of the food eaten is either meat-based or processed, very little fruits, veggies, and whole grains.
All of these men made major contributions in the study of CVD epidemiology. Names like Ancel Keys, Isidore Snapper and I'm sure there are others who have also paved the way. This is only my short reading of this topic. Here we live in modern times with all this wonderful technology and the number one cause of death is heart disease. And Dr Esselstyn calls it "a toothless paper tiger that need never exist, and if it does exist, it need never progress". What a bold statement for an industry that spends billions per year. IOW, if we just co-opted the diet of indigenous peoples in undeveloped countries of the past, we would easily be free of this dreaded disease along with all the other diseases of affluence.
We live in times that can be called "evolutionary mismatch". An evolutionary mismatch is an adaptation acquired by the human body that has become problematic given the culture or environment of modern society. We've mostly won the battle of infectious diseases and now we're losing the battle of degenerative diseases. Perhaps it's inevitable. Doctors Campbell, Esselstyn, McDougall et al say it's not. With lower mortality and higher morbidity, we're living longer lives but with higher disability adjusted living years (DALY). Learning from the great doctors and pioneers of the past, each one of us can take steps to live a more healthful life.