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constructed. One was Paul Dudley White’s declaration that a “great epidemic” of heart disease had ravaged the country since World War I . The other could be cal ed the story of the changing American diet. Together they told of how a nation turned away from cereals and grains to fat and red meat and paid the price in heart disease. The facts did not support these claims, but the myths served a purpose, and so they remained unquestioned.
    The heart-disease epidemic vanishes upon closer inspection. It’s based on the proposition that coronary heart disease was uncommon until it emerged in the 1920s and grew to become the nation’s number-one kil er. The epidemic was a “drastic development—paral eled only by the arrival of bubonic plague in fourteenth-century Europe, syphilis from the New World at the end of the fifteenth century and pulmonary tuberculosis at the beginning of the nineteenth century,” the Harvard nutritionist Jean Mayer noted in 1975. When deaths from coronary heart disease appeared to decline after peaking in the late 1960s, authorities said it was due, at least in part, to the preventive benefits of eating less fat and lowering cholesterol.
    The disease itself is a condition in which the arteries that supply blood and oxygen to the heart—known as coronary arteries because they descend on the heart like a crown—are no longer able to do so. If they’re blocked entirely, the result is a heart attack. Partial blocks wil starve the heart of oxygen, a condition known as ischemia. In atherosclerosis, the coronary arteries are lined by plaques or lesions, known as atheromas, the root of which comes from a Greek word meaning “porridge”—what they vaguely look like. A heart attack is caused most often by a blood clot—a thrombosis—typical y where the arteries are already narrowed by atherosclerosis.
    The belief that coronary heart disease was rare before the 1920s is based on the accounts of physicians like Wil iam Osler, who wrote in 1910 that he spent a decade at Montreal General Hospital without seeing a single case. In his 1971 memoirs, Paul Dudley White remarked that, of the first hundred papers he published, only two were on coronary heart disease. “If it had been common I would certainly have been aware of it, and would have published more than two papers on the subject.” But even White original y considered the disease “part and parcel of the process of growing old,” which is what he wrote in his 1929 textbook Heart Disease, while noting that “it also cripples and kil s often in the prime of life and sometimes even in youth.” So the salient question is whether the increasing awareness of the disease beginning in the 1920s coincided with the budding of an epidemic or simply better technology for diagnosis.
    In 1912, the Chicago physician James Herrick published a seminal paper on the diagnosis of coronary heart disease—fol owing up on the work of two Russian clinicians in Kiev—but only after Herrick used the newly invented electrocardiogram in 1918 to augment the diagnosis was his work taken seriously. This helped launch cardiology as a medical specialty, and it blossomed in the 1920s. White and other practitioners may have mistaken the new understanding of coronary heart disease for the emergence of the disease itself. “Medical diagnosis depends, in large measure, on fashion,” observed the New York heart specialist R. L. Levy in 1932. Between 1920 and 1930, Levy reported, physicians at New York’s Presbyterian Hospital increased their diagnosis of coronary disease by 400 percent, whereas the hospital’s pathology records indicated that the disease incidence remained constant during that period. “It was after the publication of the papers of Herrick,” Levy observed, that “clinicians became more alert in recognizing the disturbances in the coronary circulation and recorded them more frequently.”
    Over the next thirty years, recorded cases of