Revisiting the point-source hypothesis of the coronary heart disease epidemic in light of the COVID-19 pandemic
The 20th century coronary heart disease pandemic remains a partial enigma. Here we focus on sex differences in mortality as an indicator of the disease during a time when classification of cause of death was uncertain. We suggest that cohorts born during a few decades around the turn of the century bore the brunt of the pandemic, and propose that the 1889-1895 Russian influenza epidemic may have contributed to this. That some evidence points to the introduction of a human seasonal coronavirus during the 1889-95 pandemic adds contemporary relevance to these speculations. …
…In the current pandemic, continued elevated risk for overall arterial events (including CHD and ischaemic stroke) has been reported at 36 weeks post infection (Figure 17, Reference 30) and this has persisted beyond this time. Whilst underlying risk could generate this finding, it is possible that repeat infection in an early 20th century population among which artificial vaccination was obviously not available led to a long-lasting relative elevation in risk. Further work on this highly speculative hypothesis will primarily depend upon identifying historical human and bovine samples allowing precise identification of when HCoV OC43 was introduced into human populations. Longer follow up individuals infected with SARS-CoV-2 when they were immunologically naïve, with a comprehensive set of sensitivity analyses, will allow better characterisation of possible the long-term cardiovascular effects of a novel HCoV entering human populations.
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