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The origins of ischaemic heart disease are obscure. The article discusses the influence of environment, heredity and diet (especially for consumption). It is then proposed that dietary deficiencies of copper may be a factor that enhances risk of the disease. The evidence for this is discussed.

Coronary heart disease, which is sometimes called ischaemic heart disease, is the major cause of death in the United Kingdom. Much more is known, and even more talked about, the relationship between coronary heart disease (CHD) and diet than any other type of medical disorders except for the deficiency diseases.

Data from sophisticated portable heart‐rate monitors and “work diaries” were used to relate in Mintzberg's “nature of managerial work” to physiological stress in a small sample of working principals. Subjects were categorised by years of experience, Type A and Type B personality, and were “shadowed” for three complete work days in their schools doing regular activities to learn what management functions were stressful. Principals were found to be working under extreme stress (a few at catastrophically high levels), for long hours, and that certain managerial activities were more physiologically stressful than others. Implications for training, deployment and the use of bio‐feedback techniques are discussed.

In 1988 over half of the deaths in the world were due to heart disease. The recognised risk factors for coronary heart disease are smoking, plasma cholesterol levels and hypertension. These factors, however, account only for some 50‐60 per cent of the variance in incidence of the disease between countries; so other factors must contribute. Recent biochemical evidence suggests that in conditions of oxidant stress a relative deficiency in antioxidants, in conjunction with a relatively high concentration of oxidisable substrates such as cholesterol, may play an important role in the development of atheroma. The efficiency of the human antioxidant defence system depends in part on an adequate intake of foods containing antioxidants such as vitamins C and E. Until intervention trials with these antioxidants show positive effects in reducing coronary heart disease, advising the general population to increase intake of Vitamin C and E is contentious. On the other hand increasing consumption of fruit and vegetables is unlikely to do any harm, and may do us some good.

The Walsall clinic for survivors of myocardial infarction is described. Coronary heart disease is a major health issue in Walsall. The starting point for the project was the publication of the Scandinavian Simvastatin Survival Study (4S) in 1994, which showed the benefit of cholesterol treatment in these patients. Although the new clinic was established primarily to implement a 4S‐based regime, the cholesterol regime has been modified in the light of newer evidence, and the service broadened to encompass cardiological assessment and the use of other forms of secondary prevention. Several factors have contributed to the success of the service, including support from the Health Authority, patient involvement, partnership with Primary Care and the use of information technology. The latter has integrated routine clinical record keeping and correspondence with complete prospective audit data accumulation and measurement of performance against evidence‐based standards. These principles are of potential value in other clinical effectiveness initiatives.

There is growing evidence to suggest that childhood deprivation is linked to social inequalities and has important consequences for health in later life. Past studies tend to focus on the influence of cumulative deprivation on the risk of developing a particular disease. This study adds to the literature by exploring how deprivation in childhood may be linked to how people (who already have a disease) self-manage their condition in later life. Questionnaires and focus groups were analysed to explore this relationship (n=91) among coronary heart disease patients living in a deprived urban area of Northern England. The results suggest that childhood deprivation may influence health behaviours and lifestyle in later life especially with regard to diet, health locus of control and doctor visits.

The effect of diet on coronary heart disease has been the subject of much research and controversy in recent years. In 1970 a panel was set up by the Committee on Medical Aspects of Food Policy (Nutrition) to advise on the significance of any relationships and on any indications for future action and for the formulation of a United Kingdom food policy. The panel's report was published in June 1974. The panel's members studied and discussed an enormous volume of published work from all over the world, and had meetings with a number of experienced investigators. The report's bibliography contains almost 400 papers, both published and unpublished. The report is almost entirely confined to an interpretation of the evidence as it applies to man; although atherosclerotic thickening of arterial walls occurs in other species, thrombotic obstruction appears to be found only in man.

The purpose of this study is to biomedically assess biscuits designed to reduce selected risk factors for coronary heart disease, in particular serum homocysteine and glucose.

In this study, one of the countries leading jam sandwhich biscuits was significantly modified, with particular attention being paid to sugar, fat and salt concentration. A traditional biscuit was converted to a functional food by the addition of vitamin B₁₂, Folic Acid, Vitamin C and Prebiotic fibre, while reducing salt and sugar.

The results obtained from a clinical trial demonstrated that serum homocysteine and blood glucose were significantly decreased (P < 0.05) when the modified product and the traditional biscuit were compared. These findings confirm that a health promoting biscuit can be produced commercially, and have similar organoleptic properties as the standard high fat, high sugar and salt product.

These findings could have significant implications to the biscuit industry, as producers of products traditionally associated with poor health. This study shows that biscuit formulations can be modified significantly, and that the resultant dough yield biscuits which can be produced under commercial conditions, be organoleptically acceptable and reduce risk factors associated with coronary heart disease.

Moving into the twenty‐first century, there is no reason why biscuit consumption should be associated with poor health. Recipe and processing modifications are possible, thanks to new and innovative raw materials and an understanding of dough rheology.

A new report from the National Heart Forum argues that coronary heart disease could lose its position as the leading single cause of death in the UK if only knowledge we have now can be turned into effective policy action. Tackling health inequalities, largely due to relative poverty, must begin in childhood. National nutrition policies are needed to lower average blood cholesterol levels and unhealthy weight gain. Healthy choices in food and lifestyle must be available to all, not just the better off. Government strategies to tackle smoking must be matched by similar strategies for nutrition and physical activity. A failure to act, particularly to raise nutritional standards across the board, could result in an alternative scenario of huge and costly increases in the number of coronary care patients.

Coronary artery disease (CAD) is developed by an insufficient supply of oxygen-rich blood to the myocardium. Recent studies have shown that increased oxidative stress has implicated in the pathogenesis of coronary atherosclerosis. Anxiety and CAD have a mutual relationship, as the effect of long-lasting anxiety on atherosclerosis and CAD is well known. The purpose of this study is to investigate the relationship between dietary / serum total antioxidant capacity and CAD.

A total of 160 male patients were enrolled in this cross-sectional study. Diagnosis and analysis of angiograms were performed visually by a cardiologist. The subjects were categorized into CAD− (coronary artery obstruction <75 per cent) and CAD+ (coronary artery obstruction ≥ 75 per cent) groups. Anthropometric indices, blood pressure, blood sugar and lipid profile and physical activity (PA) were assessed. Information about anxiety was obtained by Spielberger questionnaire. Dietary total antioxidant capacity (TAC) was obtained by using a semi-quantitative food frequency questionnaire and an oxygen radical absorbance capacity of selected foods.

Mean of dietary TAC was significantly lower in CAD+ than CAD− group (P < 0.001). However, there was not any significant differences about serum TAC (P = 0.28). The mean of body mass index (BMI) (P = 0.04) and triglyceride (TG) level (P = 0.03) and the frequency of smoking (P = 0.03) were significantly higher in the CAD+ than the CAD− group. There was no significant relationship between CAD with apparent (P = 0.33) and hidden anxiety level (P = 0.16). Confounding factors such as smoking and medications were adjusted.

This study had certain limitations. Being a single center cross-sectional design does not permit analysis of causal relationships; the sample size was geographically limited. The authors could not exclude the medication of patients, which could affect the total antioxidant capacity levels. Measurement error in self-reported dietary consumption may results misclassification of exposure.

A diet high in total antioxidant capacity is inversely associated with CAD. Serum TAC does not vary between men with and without CAD when confounders including age, BMI, TG, smoking, SBP, DBP, energy intake, PA, HDL-C, LDL-C, T-C, FBS, family history of CAD, education and anxiety are taken into consideration.

High consumption of vegetables and fruits may play a major role in the prevention of CAD.

The study was approved by the ethics committee of Isfahan University of Medical Sciences (No:394888).