The male epidemic: 50 years of ischaemic heart disease

The death rate from ischaemic heart disease (IHD) is now much higher in males than in females. This sex differential can be used to trace the development of the modern IHD epidemic in males, since the ratio of the male to female death rate is relatively unaffected by changes in diagnostic accuracy, medical fashion, and statistical classification. Male and female death rates were similar (and the sex ratio therefore close to unity) until the 1920's, since when the ratio has risen steadily, reaching a level of over 6:1 in some age groups by 1971. Other diseases of the heart and closely related “near heart” diagnoses have not shown any compensatory decline in their sex ratios, indicating that the rise in the IHD sex ratio has not simply been due to re-allocation of deaths from these categories.