Book Review

Coronary Heart Disease Epidemiology: From Aetiology to Public Health

N Engl J Med 1993; 329:737September 2, 1993

Article

Coronary Heart Disease Epidemiology: From Aetiology to Public Health
Edited by Michael Marmot and Paul Elliott. 547 pp. New York, Oxford University Press, 1992. $89. ISBN: 0-19-262124-6

This massive book of more than 500 pages, with 50 contributors, is a fitting tribute to the work of Geoffrey Rose, who retired two years ago from the position of professor of epidemiology at the London School of Hygiene and Tropical Medicine. Rose's contribution to epidemiology and public health includes the restatement of the key idea that the major diseases affecting public health are determined by the nature of society as a whole, not by the behavior of a few people at high risk. As well as an eminent epidemiologist, he was a practicing clinician and brought the human touch to epidemiology.

This book serves two purposes; it is a Festschrift to Rose, and it is a textbook on the epidemiology and prevention of cardiovascular disease. A brief introduction describes recent trends in mortality from coronary heart disease and summarizes the contribution of epidemiology to the development of knowledge about the occurrence of coronary heart disease. The second, and most important, part reviews the major risk factors for coronary heart disease from a variety of perspectives. This is the strongest section of the book, but inevitably, with more than 19 chapters, there is some duplication; in addition, there is, rather surprisingly, little on alcohol and heart disease. The third section focuses on public health and appropriately begins with a chapter by Rose on strategies of prevention. It summarizes his critical contributions to the way we now think about the prevention of chronic diseases.

The great strength of this book is that it brings together and summarizes a mass of detail. Although most of this material has been published elsewhere, it is of great benefit to have it in one book. Most of the authors are European, and inevitably the European perspective on prevention dominates. Although there is much discussion of the need for public policies to prevent coronary heart disease, there is little discussion of how these policies might be implemented. The required strategies for controlling the epidemic of disease caused by the tobacco industry and for dietary change are outlined, but the links between evidence and policy are left vague. The lack of influence of evidence on policy is also demonstrated in a striking chapter that summarizes the evidence against cholesterol screening. Although the development of the epidemic of coronary heart disease in Eastern Europe is highlighted, little attention is paid to the emerging epidemic in developing countries, and the appropriate lessons from industrialized Europe are not identified.

This book will be of particular interest to those who want to bring themselves up to date on the wide field of coronary heart disease epidemiology and, in particular, to postgraduate students in epidemiology and public health. Apart from the detail in the book, there are fascinating forewords that provide insight into Geoffrey Rose's character.

Robert Beaglehole, M.D., F.R.A.C.P.
University of Auckland School of Medicine, Auckland, New Zealand