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(Circulation. 1996;93:1755-1764.)
© 1996 American Heart Association, Inc.

Articles

Cardiovascular Disease Epidemiology

A Journey From the Past Into the Future

Frederick H. Epstein, MD, FRCP

From the Institute of Social and Preventive Medicine, University of Zurich, Switzerland.

Correspondence to Dr Henry Blackburn, Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN 55454.

	Setting the Stage

 
When Ancel Keys established the Laboratory of Physiological Hygiene at the University of Minnesota in 1946, cardiovascular disease (CVD) epidemiology did not exist. It came into being through the vision and efforts of a small group. Collaboration among the early workers developed, and by the end of the 1940s, this new branch of science was fully under way. The gate was opened by the launching of the first prospective studies, led by the Minnesota Business Men Study,¹ and was soon followed by the Framingham Study.² Keys's contribution was decisive from the start.³

CVD epidemiology, seen as one of the major deliberate scientific approaches to atherosclerosis research, almost seemed to come from nowhere, like a nova or the "big bang." In the late 1940s, there were forerunners, but, as always with the birth of creative ideas, there will remain some mystery around the reasons for this explosive development; it led within 30 years to coronary heart disease (CHD) becoming a largely preventable condition. The extent of this dramatic change is mirrored by the fact that the word "prevention" was not even mentioned in the report of the first symposium on CVD epidemiology, organized by Ancel Keys and Paul D. White on the occasion of the World Congress of Cardiology in Washington in 1954.⁴ It would seem that they saw no point in paying lip service to the self-evident target of prevention before the scientific foundations for preventive action had been laid.

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