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BMJ. Sep 22, 2001; 323(7314): 695.
PMCID: PMC1121251

“Coronary heart disease” is not tautologous

Hugh Tunstall-Pedoe, professsor of cardiovascular epidemiology

Editor—Gilroy repeats a common misconception in suggesting that the term “coronary heart disease” is a new term and that it is a tautology.1 It is an established North American term, to be preferred to the British synonym “ischaemic heart disease,” which dominates recent editions of the International Classification of Diseases.2 Ischaemic is imprecise and could, as Friedberg pointed out 35 years ago, apply equally well to heart disease secondary to stenosis of the aortic valve, or even to anaemia.3 “Coronary” does not mean cardiac but “resembling, or encircling, like a crown.”4 It was the 17th century anatomists' descriptive name for the arterial pattern around the heart.

Coronary artery disease is used, confusingly, to mean pathological findings confined within the coronary arteries. These changes are present in almost all adults and are usually symptomless. It is only when changes to the coronary arteries are severe enough to affect the myocardium, to cause coronary heart disease, that patients are truly diseased—from angina, myocardial infarction, sudden death, or heart failure. Coronary heart disease means that the heart as an organ is involved, necessitating secondary prevention, whereas we all have coronary artery disease for decades beforehand and try to slow its progression to heart disease by primary prevention. Heart disease and heart attacks are too non-specific as terms to get by without qualification. Twenty five years ago I tried to introduce “coronary heart attack” as a generic term to cover both cardiac infarction and coronary deaths (often unassociated with infarction), but without success.5


1. Gilroy F. Tautology, or not tautology. BMJ. 2001;322:1606. . (30 June.) [PubMed]
2. World Health Organization. International statistical classification of diseases and related health problems. 10th revision. Geneva: WHO; 1992.
3. Friedberg CK. Diseases of the heart. 3rd ed. Philadelphia: Saunders; 1966. p. 643.
4. Concise Oxford Dictionary. 7th ed. Oxford: Oxford University Press; 1982.
5. Tunstall-Pedoe H, Clayton D, Morris JN, Brigden W, MacDonald L. Coronary heart attacks in east London. Lancet. 1975;ii:833–838. [PubMed]

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