From 1963 (the peak year) to 1985, the age-adjusted death rate fell by 42%. But the decline in IHD has been much greater than the decline in smoking. And when the data are analyzed by sex, the discrepancy is even more marked.

Smoking has declined less in women than in men (16% v 37%), and even anti-smokers claim less IHD risk in women from smoking, yet the decline in IHD has been proportionally equal in men and women. Women began quitting later than men, but the decline began at the same time.

A much greater percentage of older women smoke than in the past, which would supposedly cause an increase in the death rates in those age groups, yet the decline in IHD has been about the same as at younger ages. Women's IHD death rates declined in 26 countries from 1950 to 1978, while men's increased in most of those countries during this time.

Other factors that doctors like to invoke don't explain the IHD decline, either. Deaths from high blood pressure began declining around 1950, while IHD was still increasing. Death rates fell just as quickly among the old, who did not embrace the exercise mania of the young. IHD increased during the Depression, rather than decreasing as they would if a rich diet caused it. The decline began before there were any large-scale changes in diet, which are not sufficient to account for it anyhow. Nor are improvements in treating heart attacks; 60-70% of deaths still occur outside the hospital.

Whatever caused the decline affected both sexes, and all ages and races, simultaneously and equally, with greater strength than any known influence. The 1978 Conference on the Decline in Coronary Heart Disease Mortality (of the National Heart, Blood, and Lung Institute) concluded that they did not know why the rise occurred, why it ended, or why it turned downward. Like other explanations, decreased smoking does not fit the ticket.

Main references:

Mortality data are from Vital Statistics of the United States 1950-1989.

Higgins MW, Luepker RV. Preface and Appendix. In: Trends in coronary heart disease. Higgins MW, Luepker RV, eds. New York: Oxford Univ Press, 1988. pp vii-x.

Stallones, RA. The Rise and Fall of Ischemic Heart Disease. Sci Am 1980 Nov;243(5):53-59.

Thom TJ, Maurer J. Time trends for coronary heart disease mortality and morbidity. In: Trends in coronary heart disease. Higgins MW, Luepker RV, eds. New York: Oxford Univ Press, 1988. pp 7-15, Ch 1.

Courtesy of Carol Thompson 08/23/93
Smokers' Rights Action Group Smokers' Rights Action Group P.O. Box 259575 Madison, WI 53725-9575 Phone: 608-249-4568