THE MAIN CAUSE OF INCREASED DEATH RATE FROM DISEASE OF THE HEART: 1920 TO 1959

Past and future corollaries of theories on causes of metabolic syndrome and obesity related co-morbidities part 2: a composite unifying theory review of human-specific co-adaptations to brain energy consumption

Metabolic syndrome (MetS) predicts type II diabetes mellitus (TIIDM), cardiovascular disease (CVD) and cancer, and their rates have escalated over the last few decades. Obesity related co-morbidities also overlap the concept of the metabolic syndrome (MetS). However, understanding of the syndrome's underlying causes may have been misapprehended. The current paper follows on from a theory review by McGill, A-T in Archives of Public Health, 72: 30. This accompanying paper utilises research on human evolution and new biochemistry to theorise on why MetS and obesity arise and how they affect the population. The basis of this composite unifying theory is that the proportionately large, energy-demanding human brain may have driven co-adaptive mechanisms to provide, or conserve, energy for the brain. A 'dual system' is proposed. 1) The enlarged, complex cortico-limbic-striatal system increases dietary energy by developing strong neural self-reward/motivation pathways for the acquisition of energy dense food, and (2) the nuclear factor-erythroid 2-related factor 2 (NRF2) cellular protection system amplifies antioxidant, antitoxicant and repair activity by employing plant chemicals. In humans who consume a nutritious diet, the NRF2 system has become highly energy efficient. Other relevant human-specific co-adaptations are explored. In order to 'test' this composite unifying theory it is important to show that the hypothesis and sub-theories pertain throughout the whole of human evolution and history up till the current era. Corollaries of the composite unifying theory of MetS are examined with respect to past under-nutrition and malnutrition since agriculture began 10,000 years ago. The effects of man-made pollutants on degenerative change are examined. Projections are then made from current to future patterns on the state of 'insufficient micronutrient and/or unbalanced high energy malnutrition with central obesity and metabolic dysregulation' or 'malnubesity'. Forecasts on human health are made on positive, proactive strategies using the composite unifying theory, and are extended to the wider human ecology of food production. A comparison is made with the outlook for humans if current assumptions and the status quo on causes and treatments are maintained. Areas of further research are outlined. A table of suggestions for possible public health action is included.

Global perspective on acute coronary syndrome: a burden on the young and poor

Ischemic heart disease (IHD) is the greatest single cause of mortality and loss of disability-adjusted life years worldwide, and a substantial portion of this burden falls on low- and middle-income countries (LMICs). Deaths from IHD and acute coronary syndrome (ACS) occur, on average, at younger ages in LMICs than in high-income countries, often at economically productive ages, and likewise frequently affect the poor within LMICs. Although data about ACS in LMICs are limited, there is a growing literature in this area and the research gaps are being steadily filled. In high-income countries, decades of investigation into the risk factors for ACS and development of behavioral programs, medications, interventional procedures, and guidelines have provided us with the tools to prevent and treat events. Although similar tools can be, and in fact have been, implemented in many LMICs, challenges remain in the development and implementation of cardiovascular health promotion activities across the entire life course, as well as in access to treatment for ACS and IHD. Intersectoral policy initiatives and global coordination are critical elements of ACS and IHD control strategies. Addressing the hurdles and scaling successful health promotion, clinical and policy efforts in LMICs are necessary to adequately address the global burden of ACS and IHD.

The hypothetical epidemic of coronary heart disease and atherosclerosis

Accurate usage of the term 'epidemic' is important scientifically and it should ideally be used to mean only contagious diseases, not used loosely or emotively to mean non-infectious diseases, particularly coronary heart disease, which is a non-specific complication of many diseases. It should not be used as a surrogate term for atherosclerosis of indefinite severity. An epidemic of atherosclerosis is impossible, there being no variation in prevalence because the disease is ubiquitous. Moreover, vital statistics are too unreliable to determine the existence of an increase or decline in coronary heart disease. A coronary heart disease epidemic could be due to an increase in non-atherosclerotic coronary heart disease or increased severity of atherosclerosis. The former has not been studied and the latter would cause a shift to the left in age distribution and is inconsistent with the fall in 'all cause' and stroke mortality rates whilst coronary heart disease mortality allegedly increased alarmingly. A coronary heart disease epidemic, having no scientific basis, negates any reason for the sustained search for a speculative causative environmental factor.

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.

Some forms of undiagnosed coronary disease in Nineteenth-century England

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The biology of myocardial infarction

Myocardial infarction is a dreaded companion of the civilization of our time. The "heart attack," the coronary thrombosis, the myocardial infarction lurk behind the corner, striking strangers, patients, friends, and ourselves. The toll taken by this single "disease" in many hospitals equals or even exceeds that from almost all other diseases together. Must it be so? This is the question many physicians, and the lay public, are asking themselves today.

Identification of some areas where our knowledge is particularly deficient is stressed. We must concentrate our efforts on reevaluating practices and procedures that have brought both the greatest success and the worst failures, at the same time that we ask ourselves what goals could be considered realistic.

If myocardial infarction is the evil of our time, what does this mean in a greater biological context-in the evolution of human life and endeavor as viewed in perspective? Are we dealing with a "disease" in the restricted sense of the word, or are we dealing with a way of life and a consequent mode of death? If so, what can be done to achieve the goals of health as defined by the World Health Organization? In what terrain are the forces to be assembled and the battle to be fought-and by whom.