An appraisal of the epidemic rise of coronary heart disease and its decline.

Epidemiologists have used mortality statistics to demonstrate a sharp rise in the incidence of coronary heart disease in several countries since the turn of the century and a decline in some countries since the late 1960s. However, increased longevity, changes in coding and diagnostic practices, and familiarity with the clinical and pathological features of the disease make the increase largely spurious. Diagnostic errors in certified causes of death in general, and coronary heart disease in particular, indicate that vital statistics are too unreliable for determining whether there has been an increase and a subsequent decline in the incidence of coronary heart disease.