Interactions between nutrition and heredity in coronary heart disease

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Abstract
An analysis is presented of the demography of coronary heart disease (CHD) in the male population of the United States and of the nature of genetic and environmental (chiefly nutritional) factors contributing to the incidence in individual men. The estimation of risk is based on the "multivariate analysis" developed for the epidemiologic study at Framingham, Mass. A model calculation is made for all United States men initially 30 to 39 years of age over three decades of middle life. This reveals that CHD occurs in more than 50% of those at highest risk compared with only 14% of low risk men. Men above the 80th percentile in risk contribute 40% of the total CHD, whereas those below the 50th percentile in risk contribute only approximately 25%. It is proposed that major risk factors are principally under "polygenic control," which is defined and illustrated with the principles of biochemical genetics. Nutritional status and other environmental factors are shown to modulate, but not to override, the expression of the genotype. Important implications of polygenic inheritance and its modulations are that CHD is not expected to be amenable to specific preventive measures, but that multiple interventions against risk factors, each of modest effect, will interact to achieve major reduction of risk. The concept of "individualized preventive medicine" is recommended to practitioners. A credible degree of success in preventive management would halve the total incidence of CHD; however, the fundamental genetic influence on risk would remain in evidence.