The changing face of heart disease and stroke

Philip J. Goscienski, M.D.

March 2006

Step back in time and you'll find that your ancestors of the 19th century suffered from heart disease and stroke but these diseases are different today.

In the early years of the last century lots of people died from heart disease but it was not from heart attacks. In fact, heart attacks as we know them now were so rare back then that the first report of myocardial infarction, the medical term for death of a portion of heart muscle, didn't appear in a medical journal until 1912. Dr Paul Dudley White, renowned cardiologist and personal physician of President Dwight D. Eisenhower, kept a log of his hospitalized male patients between 1912 and 1913. Among 700 patients there was only one with a classic heart attack, a condition caused by coronary thrombosis (a blood clot within an artery that provides oxygen to heart muscle). Fast-forward to 2006. Among the nearly one million yearly victims of heart disease, fully one-third die of heart attacks.

When a physician lost a patient from heart disease in the early 20th century it was usually from rheumatic fever, a disease that is rare today because of antibiotics like penicillin. Other patients died because their heart valves were scarred and distorted by syphilis or other infections. Children with congenital heart abnormalities rarely survived the first year.

We have virtually eliminated rheumatic fever and syphilis; pediatric heart surgeons are able to repair almost every variety of heart defect. But we have allowed inactivity and abysmal dietary habits to cancel out these advances. Coronary artery disease is a disease of civilization. It simply does not exist in hunter-gatherer populations.

Not all strokes are the same, either. Have you heard the term apoplexy? It goes back to the 14th century and refers to the rupture of a blood vessel within the brain and it was the most common form of stroke a century ago. Such a hemorrhagic stroke is often fatal within a day or two. Thanks to our artery-clogging lifestyle, ischemic stroke has replaced the hemorrhagic variety; a portion of the brain dies because a blood vessel becomes too narrow to deliver sufficient oxygen and nutrients. Less often fatal, ischemic strokes result in years, perhaps decades, in which the victim is unable to communicate, to see or to walk unaided.

Even hemorrhagic strokes of the modern era are lifestyle-related, usually due to high blood pressure — a condition that has increased several-fold in just 3 or 4 generations.

Type 2 diabetes is the linchpin of modern maladies. The most profound effect of diabetes is on blood vessels. At triple the rates of only two generations ago it has accelerated the rise in coronary artery disease and ischemic stroke.

How different would our world be if we had kept the gains of the past and held at bay the diseases of the present? Ninety-five percent fewer heart attacks, 90 percent fewer strokes, 80 percent fewer cancers, 98 percent less type 2 diabetes.

An intriguing thought — and a worthy target.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at