An hypothesis: the dramatic decline in heart attacks in the United States is temporally related to the decline in duodenal ulcer disease and Helicobacter pylori infection

Background: Studies of autopsies of military members dying in three US wars indicate that the prevalence of atherosclerosis in successive cohorts of healthy young men and women has dramatically decreased over the past half century.

Objective: The objective of this study was to compare the decline in the prevalence of atherosclerosis and myocardial infarction with previously published studies on the decline in the prevalence of duodenal ulcer.

Methods: A plot of the prevalence of coronary atherosclerosis and the prevalence of myocardial infarction in three cohorts of young men and women born from 1930 to 1980 was constructed.

Results: The figure shows a marked decline in prevalence in atherosclerosis beginning in a military cohort born around 1930 and a similar marked decline in prevalence of myocardial infarction in the US population beginning in 1970. In published studies duodenal ulcer began to decline in prevalence in 1960. As duodenal ulcers began to occur at age 30 and myocardial infarctions began to occur at age 40 at the time of peak prevalence, the cohort born in 1930 was the first to experience a decline in prevalence of both duodenal ulcer and heart attacks.

Conclusion: The study shows that the decline in heart attacks is temporally related to the decline in duodenal ulcer and by inference, Helicobacter pylori infection.