Origins of the Cardiovascular Mortality Epidemic in the United States, 1920–90

Andrew Noymer, University of California, Irvine
Steven Tate, University of Chicago

During the twentieth century, as other causes of death declined, cardiovascular mortality increased in the United States. By the late 1950s, the age-standardized death rate (ASDR) for cardiovascular causes was almost double that for all other causes, combined. The late 1950s/early 1960s was the peak of what would be a roughly 70-year epidemic. By the the late 1980s, a spectacular volte-face had been completed, with the ASDR for cardiovascular causes less than that for other causes combined. We show that a prior imaginative hypothesis of Azambuja and Levins (2007) — that the 1918 influenza pandemic caused the cardiovascular mortality epidemic — is a poor match to the available data. We advance an alternative hypothesis, that a combination of diet and changes in the human microbiome wrought by the advent of antibiotics in the 1950s, was responsible for the main trends of cardiovascular mortality in the US in the twentieth century.