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New direction for medical research

The epidemic of cardiovascular disease is beginning to ease with fewer acute myocardial infarctions, deaths and strokes. In the USA, the epidemic of cardiovascular disease appears to have peaked in 1980 for men and in 2000 for women.1 In developing countries, the epidemic continues to rise. There is some fear that advancing obesity and diabetes will erase the current declines in the disease most responsible for the death and disability. How did medical science achieve these goals?

In 1950, myocardial infarction was a mystery. A seemingly healthy young male or older grandmother would suddenly be struck down with chest pain followed by a sudden death or 50% mortality within the hospitalisation. In 1948, the National Heart Institute began a longitudinal study of 5209 inhabitants of Framingham, Massachusetts.2 The purpose of the study was to identify risk factors for development of disease. The study has expanded and now includes children and grandchildren. It identified smoking, cholesterol, hypertension, diabetes and inactivity as characteristics that were associated with disease. These factors, although statistically significant, had no apparent direct link to the process of myocardial infarction.

Coronary thrombosis was a term for myocardial infarction, but at that time thrombosis was not clearly demonstrated. Post mortem examination often lacked a clot or was confused with post mortem clotting. The theories of coronary thrombosis versus demand outstripping supply due to vessel narrowing by atherosclerosis were debated until 1986 when angioscopy demonstrated clot within the vessel of a patient suffering from acute myocardial infarction.3 Once clot was definitively identified, fibrinolysis, antithrombotics and antiplatlets were developed, attacking the clot that was at least linked to the disease process. Trials began to test the hypothesis that if a blood clot could be dissolved, outcomes would be better. These trials were successful and have helped curb the …