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In the 1950s, World Health Organization data indicated that for Italy and several other Mediterranean countries, death from coronary he art disease (CHD) was much less common than in Northern Europe or the U.S. What has happened to this “Mediterranean advantage” in the ensuing years? Death from CHD in the 1980s is still lower in Italy than in the U.S., but the gap has narrowed, e. g., for men age 45–64 the Italian rate was about one-third that of the U.S. rate in the early 1950s, but by the late 1970s the Italian CHD death rate was more than half that in the U.S. This narrowing reflected two trends—an important decrease in CHD death rate in U.S. men and rising CHD rates for middle-aged Italian men from the 1950s through the middle 1970s.

There is no doubt that marked regional differences exist in the occurrence of atherosclerotic disease. Medical research has been accumulating data on this phenomenon for several decades. It is by no means a de novo discovery stemming from the post-World War II surge of research on this problem. Valuable reviews of the earlier literature, published in the 1930s, remain worthy of study (1–6). At this Boer-haave Course, it is appropriate to refer specifically to researches in the Dutch East Indies by European investigators