Book Reviews

Cardiovascular Diseases in the United States (Vital and Health Statistics Monographs, American Public Health As- sociation), by lwao Moriyama, Dean E. Krueger and Jere- miah Stamlar. Cambridge, Mass., Harvard University Press, 1971, 496 pages, $10.00

In 1958 a committee on Vital and Health Statistics Monographs was appointed by the Statistics Section of the American Public Health Association for the pur- pose of evaluating the country’s health status. Using mainly mortality and morbidity data, the committee produced a number of monographs on various health problems. Authors of the individual monographs were given a free hand, unencumbered by endorsement from the agencies that supported the work. This book is the product of such researches in the field of cardiovascu- lar diseases. The first few chapters discuss the prob- lems inherent in studies using raw data from varied sources (the National Health Survey, the Health Ex- amination Survey, military studies, hospital statistics, community studies such as Hunterdon County, Fra- mingham, Techumseh, industrial studies, closed popu- lations studies such as those of the Benedictine and Trappist monks, Federal and local mortality data and, in some instances, data available from foreign coun- tries). Changing nomenclature, reliability of reporting of deaths and other examples of sources of errors are examined cogently in these earlier chapters and again where appropriate throughout the book.

Five chapters deal with coronary, hypertensive, rheumatic and congenital heart disease and cerebro- vascular disease. Each chapter begins with a concise definition and description of the disease and the mag- nitude of the problem. Data on age, sex, color, geo- graphic division, urban vs. rural area, educational level, marital status, country of birth, prevalance, incidence, risk factors, mortality trends and international com- parisons are presented and fully discussed in an inter- esting manner, with hypotheses suggested to explain the findings.

Aside from the usual statistics, the book presents many interesting correlations not widely appreciated. For instance, mortality rates from coronary heart dis- ease and hypertension are higher among the widowed, divorced and single than in those who are married (ex- cept among white single women over age 55 years). Mortality from coronary disease is roughly inversely proportional to educational levels, especially among women, but also among men aged 25 to 64 years. Age- corrected death rates are highest in metropolitan coun- ties containing central cities, lowest for nonmetropoli- tan counties and intermediate for metropolitan counties not containing central cities. This holds for each of the 4 color-sex groups. Mortality per 100,000 due to coro- nary disease was found to be highest in the Middle Atlantic states. The states with the highest rate of death from coronary disease among white men were Washington, D.C., Nevada and South Carolina, in that order. Coronary death rates correlated with per capita cigarette sales figures. The highest death rate for all nonwhites due to hypertension was found in the South Atlantic states. Although comparative death rates due to hypertension have been reduced by 37 to 49.3 percent

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among whites in the various regions between 1949-51 and 1959-61, reductions among the nonwhite popula- tion in the same period in the South Atlantic, East south central and West south central states have been only 22.9 to 27.6 percent. The death rate due to rheu- matic heart disease has been reduced from 1940 to 1960 in all age and color groups, but especially among those younger than 24 years.

The last chapter sums up the findings for all cardio- vascular diseases combined and is followed by an ap- pendix. One of the most interesting portions of the book is the first 26 pages of the appendix in which a capsule history of cardiovascular medicine is presented. In addition to the text there are more than 220 tables and 35 figures. The book is adequately indexed and con- tains bibliographies for each chapter.

This volume is an important contribution and will be a useful reference in the epidemiology of cardiovascu- lar disease. In addition to the value of the book for researchers, the interesting array of facts presented and the thoughtful discussions of the data make it a valuable book for teachers and clinicians involved in the discussion of cardiovascular disease with students and with patients.

Jacob I. Haft, MD Bronx, New York

Principles of Cardiac Arrhythmias, by Edward K. Chung, MD. Baltimore, Williams and Wilkins, 1971, 540 pages

Dr. Chung has written a classic but detailed overview of clinical cardiac dysrhythmias. There is a short in- troduction embracing the anatomy, electrophysiology and hemodynamics of various cardiac dysrhythmias. Interesting and informative electrocardiograms are presented for the major catagories of cardiac dysrhyth- mias, including atrial, atrioventricular nodal, ventricu- lar and Wolff-Parkinson-White types of disturbances of impulse formation. Parasystole, electrical alternans and aberration are also included in several well orga- nized chapters. Dr. Chung has offered a rather detailed analysis of the differential diagnosis of the various car- diac dysrhythmias and an approach to the management of common arrhythmias, Digitalis, electrolyte imbal- ance and arrhythmias associated with both myocardial infarction and various invasive and noninvasive pro- cedures are also included. One could take exception to the chapter on atria1 dissociation since very little in the way of physiologic data is presented to illustrate these mechanisms.

Atrioventricular block is presented well, but newer illustrations using His bundle electrograms would have added to the clarity and interest of this chapter.

The book is written with exceptional clarity. The il- lustrations are well chosen, and the bibliography is ex- cellent. The text can be recommended without hesita- tion to both students and cardiologists.

Leonard S. Dreifus, MD, FACC Philadelphia, Pennsylvania

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