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.