Heart Disease in World Leaders

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The summary below is from the full report titled "Impact of Coronary Heart Disease on World Leaders." It is in the 20 February 2001 issue of Annals of Internal Medicine(volume 134, pages 287-290). The authors are AM Girardi, LR Pyenson, J Morris, and FX Brickfield.

What is the problem and what is known about it so far?

Coronary heart disease (CHD) is a condition in which the arteries that supply blood to the heart become narrowed. When not enough blood gets to the heart, a type of chest pain called angina occurs. If the flow of blood to a section of the heart becomes blocked completely, that portion of the heart muscle dies, a condition known as myocardial infarction or "heart attack." Coronary heart disease can also lead to abnormal heart rhythms. It is a frequent cause of death among world political leaders.

Why did the researchers do this particular study?

To find out how often CHD occurs in world leaders, the type of treatment they receive, and how often leaders remain in office after an initial CHD event.

Who was studied?

The study included 64 world leaders who had a first CHD event while in office during 1970 to 1999.

How was the study done?

The researchers used media reports from the Central Intelligence Agency archives to identify world leaders who had a CHD event while in office. Leaders included the heads of government for all countries with populations of at least 250,000. Events included angina, heart attack, or abnormal heart rhythm. The researchers determined whether the leader received treatment with bypass surgery (an operation to replace the blocked arteries), angioplasty (a procedure that opens blockages from inside), or thrombolytic therapy (drugs to dissolve the blockages). They also determined whether leaders received treatment outside their own countries and whether they returned to office after their heart attacks.

What did the researchers find?

Coronary heart disease events per year decreased from almost 2 events per 100 leaders in the 1970s to about 1 event per 100 leaders in the 1990s. Death rates from CHD events also decreased over the study period. During the 1970s, 16 of 27 leaders who had an event died within 1 year, compared with 6 of 19 in the 1980s and 0 of 18 in the 1990s. During the 1970s, no leaders had invasive therapy, compared with 12 of 19 in the 1980s and 14 of 18 in the 1990s. The proportion of world leaders who received care outside their own country went from none in the 1970s to 44% in the 1990s. Of the 64 leaders identified, 42 survived longer than 1 year after the event and remained in office.

What were the limitations of the study?

The accuracy of the media reports used in this study is unknown.

What are the implications of the study?

Coronary heart disease appears to occur in world leaders less frequently, and is less deadly, now than in the 1970s. Invasive treatment and treatment outside of a leader's country have increased. A leader who experiences an initial CHD event is now likely to remain in office.