With increasing ageing in Western populations, what are the prospects for lowering the incidence of coronary heart disease?

Coronary heart disease (CHD), rare in the early 1900s, in the 1970s was res ponsible for almost a third of deaths in Western populations. Although its mortality rate has fallen in the last 20 years, considerably in certain pop ulations, it remains the leading cause of death, and there is little eviden ce of any fall in its incidence rate. The primary risk factors, which inclu de pattern of diet, smoking practice, and level of physical activity, are w ell known, but explain only similar to 50% of variation in its occurrence. Despite the numerous health improvement recommendations made, alterations i n diet have been relatively slight. Although smoking practice has halved in some populations, its prevalence is now rising in the young. The extent of physical activity is low, compared with that in the past, and may even be decreasing in the young. With the general ageing of populations, the near a bsence of strong encouragement from the state, and individuals' general fai lure to reduce risk factors significantly, the chances of decreases in the incidence of CHD appear remote.