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Plavix (Clopidogrel)

Coronary disease is common. In Great Britain it appears that at least one quarter of all deaths are due to this condition. This calculation is based on figures derived from death certificates, and may well be an underestimate. Where the estimate was more firmly based on post-mortem findings, coronary disease was the cause of death in 40 per cent of men and 20 per cent of women; these were the findings in Dr Spiekerman’s study in Rochester, Minnesota. He found narrowing of the coronary arteries in as many as 75 per cent of all adults. Many other individuals suffer from coronary disease but do not die from it. These statistics mean that heart disease due to narrowing of the coronary arteries is the commonest lethal disease in most ‘westernized’ countries. Coronary disease leads to more deaths in men than cancers, accidents or any other single cause.
Heart attacks have probably occurred throughout history, but only recently have they become so common. The heart-attack epidemic is a twentieth-century problem. Even fifty years ago our life span was limited mainly by infectious diseases; and infantile mortality was many times commoner than now.
Obviously the disease is becoming more common. But the graphs tell us more than this. If the frequency of heart attack were chiefly due to inheritance, mortality rates could hardly increase so rapidly. So changes in our environment must be chiefly to blame. This is good news; it suggests that appropriate changes in our way of life may reverse the trend and halt the epidemic of coronary heart disease.
In New York, a century ago, Dr Austen Flint did post-mortems on 150 patients who died of heart disorders: only seven had coronary disease. Not until 1912 was this form of heart disease clearly described, by Dr Herrick; he called it coronary thrombosis, in a paper which was ignored by the medical profession for years.
Until recently, heart-attack death rates continued to climb in most westernized countries. In Holland, the increase was almost twice as steep as in England and Wales. But at least one country is an exception to this rising trend. In the U.S.A., where the problem had been even greater than in the U.K., mortality from heart attack has now been falling steadily for several years. Between 1963 and 1975 the rate for middle-aged Americans fell by more than a quarter. A downward trend may be commencing in Australia, Finland and Belgium, and possibly in the U.K.
The reasons for these encouraging changes are not known with certainty. Awareness of the problem and vigorous attempts to explain preventive measures to the public, especially in the U.S.A., may have accounted for the down-turn in mortality rates. The main recommendations concerned diet and smoking habits. The American public has begun to take this advice seriously: they are using 20 per cent less tobacco than in 1963, 11 per cent less animal fats than that year, and more vegetable fats. These changes could well account in large part for the decreasing risk of heart attack.

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