The Drastic Cardiovascular Death Decline Beginning in the 1960s…What Was the Cause?

This is one of those “Six Blind Men and the Elephant” exercises where when you ask six doctors/epidemiologists/drug company reps “what has caused heart attack and stroke deaths to drop so rapidly in the last 60 years?”, you’ll get six different answers. The conventional wisdom is that: 1) a large drop in smoking, 2) medical interventions, 3) increases in statin use, 4) A decrease in fatty foods, 5) An increase in blood pressure lowering drugs and 6) A decrease in infectious diseases are responsible, but then #1–#3 largely happened about 20 years after the decline began, while #4 occurred along with an increase in carb use and an obesity epidemic. This leaves #5 (fair enough, a large contributor) and #6, which if fully understood, may be the largest contributor of all! Further, understanding of an infection’s relationship with heart attack/stroke may help fully define long-term Covid-19 risk.

Deaths per 100,000 in the US from 1900 to 2000. Note the drastic increase in heart attack and stroke from 1920 to 1960, and the subsequent drop from 1960 to 2000. What happened to both increase, then decrease the incidence of cardiovascular disease so drastically?

I remember that as a boy (around 1960), it was a different world. People were far more likely to smoke and drink hard liquor (unfiltered cigarettes and cocktails were popular then), there were few vaccines or antibiotics, we ate a lot of fatty deep-fried food, and often you’d hear about a 50 year old guy that “suddenly dropped dead of a heart attack”. The victim was often an apparently healthy guy, not always a…