Impact of coronary heart disease on world leaders.

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.