Coronary heart disease in FranceBMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6954.611b (Published 03 September 1994) Cite this as: BMJ 1994;309:611
EDITOR, - Tony Smith asks why the French have such a low incidence of coronary heart disease and, by implication, why the Scots have such a high incidence.1 I believe that a partial explanation is the way in which the evidence is gathered. In England and Wales the coroner's system ensures that fairly accurate causes of death are given in doubtful cases. No such system, to may knowledge, exists in France or elsewhere in mainland Europe. In Switzerland a death may be certified as due to a “natural internal event” (I know this because I translated all the documentation for Avon's coroner on a Bristol women who had died in Switzerland). Such a cause of death is not acceptable in Britain.
In Scotland, which does not have a coroner's system, many doctors are forced to guess the cause of death; most, surely, must opt for some form of heart attack, thereby overestimating this type of condition. France may have the equivalent of the Swiss natural internal event, underestimate the true incidence of coronary heart disease and perhaps partly explain the discrepancy between the two countries.