Impact of Coronary Heart Disease on World Leaders

  1. Alyce M. Girardi, MD;
  2. Leslie R. Pyenson, MD;
  3. Jon Morris, PhD; and
  4. Francis X. Brickfield, MD
  1. From the Central Intelligence Agency, Washington, D.C.

    Abstract

    Background: Previous studies have shown that from 1965 to 1996, coronary heart disease was a frequent natural cause of death among world leaders.

    Objective: To assess incidence of and death from coronary heart disease among world leaders and to determine the effect of this disease on office-holding ability.

    Design: Archive search of worldwide English-language and translated press and media reports from 1970 to 1999 for reference to coronary events.

    Setting: U.S. federal government medical analytic unit.

    Participants: National principal decision makers in countries with populations greater than 250 000.

    Measurements: Reports of angina, heart attack, myocardial infarction, and arrhythmia attributed to coronary artery disease; use of cardiac procedures; receipt of foreign care; death; and removal from office.

    Results: 64 leaders had initial coronary heart disease events while holding their nation's highest office. Initial event rates decreased from the 1970s to the 1990s (1.9 events per 100 person-years vs. 1.1 events per 100 person-years). Survival, use of procedures, and receipt of foreign care increased over time. Most leaders who survived an acute event continued to function in office.

    Conclusions: Incidence of and death from coronary heart disease among office-holding world leaders has decreased over the past 30 years, possibly because of increased use of cardiac procedures. A coronary event in a world leader is unlikely to presage a change in government.

    Article and Author Information

    • Disclaimer:This paper has been reviewed by the Central Intelligence Agency (CIA). That review neither constitutes CIA authentication of information nor implies CIA endorsement of the authors' views.

    • Requests for Single Reprints:Leslie R. Pyenson, MD, Central Intelligence Agency, 7G32 OHB, Washington, DC 20505.

    • Current Author Addresses:Drs. Girardi, Pyenson, Morris, and Brickfield: Central Intelligence Agency, Washington, DC 20505.

    • Author Contributions:Conception and design: A.M. Girardi, L.R. Pyenson, F.X. Brickfield.

    • Analysis and interpretation of the data: A.M. Girardi, F.X. Brickfield.

    • Drafting of the article: A.M. Girardi, F.X. Brickfield.

    • Critical revision of the article for important intellectual content: A.M. Girardi, L.R. Pyenson, J. Morris, F.X. Brickfield.

    • Final approval of the article: A.M. Girardi, L.R. Pyenson.

    • Statistical expertise: J. Morris.

    • Administrative, technical, or logistic support: A.M. Girardi, F.X. Brickfield.

    • Collection and assembly of data: A.M. Girardi, F.X. Brickfield.

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    1. Ann Intern Med February 20, 2001 vol. 134 no. 4 287-290
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