History

Heart disease is the number one killer of men and women in the United States today. In 2008, over 600,000 Americans died of the disease. Hundreds of thousands more suffered from a non-fatal heart attack.

Has this disease always plagued the human race, narrowing arteries and causing blood clots and sudden cardiac death? Or is our modern lifestyle with its high cholesterol levels and expanding waistlines to blame? A look back at the history of heart disease may surprise you.

Even Egyptian Pharaohs Had It

At the 2009 American Heart Association meeting in Florida, researchers presented study results showing that Egyptian mummies, some 3,500 years old, had evidence of heart disease—specifically atherosclerosis, which narrows the arteries. Pharaoh Merenptah, who died in the year 1203 BC, was plagued by atherosclerosis. Nine of 16 other mummies studied also had evidence of the disease.

How could this be possible? Researchers theorized that diet could be involved. High-status Egyptians ate a lot of fatty meats from cattle, ducks, and geese, and used a lot of salt for food preservation. Beyond that, the study brought up some interesting questions and has prompted scientists to continue their work to fully understand the condition. “The findings suggest,” said co-principal investigator on the study and clinical professor Dr. Gregory Thomas, “that we may have to look beyond modern risk factors to fully understand the disease.”

Early Discoveries of Coronary Artery Disease

To say exactly when civilization first became aware of coronary artery disease or artery narrowing is difficult. However, it’s known that Leonardo da Vinci (1452–1519) investigated coronary arteries. William Harvey (1578–1657)—physician to King Charles I—is credited with discovering how the blood moves: from the right ventricle of the heart through the lung and into the aorta, then the peripheral vessels, and back into the lung. Later, Friedrich Hoffmann (1660–1742), chief professor of cardiology at the University of Halle, noted that coronary heart disease started in the “reduced passage of the blood within the coronary arteries.”

Puzzling out the Problem of Angina

Angina—tightness in the chest that’s often an indicator of heart disease—puzzled many physicians in the 18th and 19th centuries. First described in 1768, it was believed by many to have something to do with blood circulating in the coronary arteries, though others thought it was a harmless condition.

The cardiologist William Osler (1849–1919) worked extensively on angina, and was one of the first to indicate that it was a syndrome rather than a disease in itself. Later, in 1912, the American cardiologist James B. Herrick (1861­–1954) concluded that the slow, gradual narrowing of the coronary arteries could be a cause of angina. He’s credited with inventing the term “heart attack.”

Learning to Detect Heart Disease

The 1900s mark a period of increased interest, study, and understanding of heart disease. In 1915, a group of physicians and social workers formed the first “Association for the Prevention and Relief of Heart Disease” in New York City. In 1924, the group became the American Heart Association. These doctors were concerned about the disease because they knew little about it. Typically, the patients they saw with it had little hope for treatment.

Just a few years later, doctors began to experiment with exploring the coronary arteries with catheters. This would later become cardiac catherization or coronary angiogram. Today, these procedures are commonly used to evaluate or confirm the presence of coronary artery disease and to determine the need for further treatment.

Both Portuguese physician Egas Moniz (1874–1955) and German physician Werner Forssman (1904–1979) are credited as pioneers in this field. Mason Sones (1918–1985), a pediatric cardiologist at The Cleveland Clinic, perfected the technique for producing high-quality diagnostic images of the coronary arteries. The new test made an accurate diagnosis of coronary artery disease possible for the first time.

The Beginnings of Watching Our Diets

In 1948, researchers under the direction of the National Heart Institute (now called the National Heart, Lung and Blood Institute) initiated the Framingham Heart Study, the first major study to help understand heart disease. In 1949, the term “arteriosclerosis” (known as “atherosclerosis” today) was added to the International Classification of Diseases, which caused a sharp increase in reported deaths from heart disease.

In 1950, University of California researcher John Gofman (1918–2007) and his associates identified today’s two well-known cholesterol types: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). He discovered that men who developed atherosclerosis had elevated levels of LDL and low levels of HDL.

Also in the 1950s, American scientist Ancel Keys (1904–2004) discovered in his travels that heart disease was rare in some Mediterranean populations where people consumed a lower fat diet. He also noted that the Japanese had low-fat diets and low rates of heart disease as well, leading him to theorize that fat was the cause of heart disease. These and other developments, including results from the Framingham Heart Study, led to the first attempts at urging Americans to change their diets for better heart health.

The Future of Heart Disease

It was in the 1960s and ‘70s that treatments like bypass surgery and angioplasty were first used to help treat heart disease. In the 1980s, the use of stents to help prop open a narrowed artery became common. As a result of these treatment advances, a diagnosis of heart disease today is no longer necessarily a death sentence.

Today, we know more about how to treat narrowed arteries to lengthen and improve quality of life. We also know more about how to reduce our risk of heart disease in the first place. But, as we’ve learned from the study on Egyptian mummies, we don’t yet know it all. We’re still a long way from completely erasing this disease from human history.