Differences in coronary heart disease in Framingham, Honolulu and Puerto Rico.

LARGE variations in the incidence of Coronary Heart Disease (CHD) have been claimed to exist around the world [l, 21. It is important to establish the validity of geographic variation in CHD incidence as it provides clues to the causes and prevention of this disease. Vital statistics have shown a lower death rate from CHD among middle aged men in Puerto Rico and in the Honolulu Japanese than in the United States white population [3, 43. To investigate this finding prospective studies were begun in 1965 in Honolulu and Puerto Rico, and the results are compared here with those from the older Framingham Study. An effort is made to evaluate geographic differences with a uniformity of methodology and diagnostic criteria in representative samples of the three populations. An attempt is also made to determine if the CHD differences observed are explained by differences in some uniformly measured risk factors in the three population samples.