The impact of stroke on world leaders.

PURPOSE: Earlier studies by our unit documented frequent disability in world leaders resulting from stroke but did not quantify the incidence of cerebrovascular accidents. We sought to identify the frequency and impact of strokes in world leaders. METHODS: Using various sources, we identified world leaders who had sustained strokes while in office from 1970 to 1999 and tabulated information on symptoms and subsequent ability to lead. RESULTS: Twenty leaders were identified who had sustained strokes during the study period, for an incidence of 0.444 strokes/100 leaders/year. Half of the affected leaders lost their political power within the year; most had persistent disabilities, which included motor, speech, cognitive, and emotional deficits. CONCLUSION: Strokes in world leaders may be slightly less common than expected based on studies of Western populations of similar age, but they are often devastating to a political career. Nonetheless, loss of political power is not inevitable.

Impact of coronary heart disease on world leaders.

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.

Patterns of death in world leaders.

This study presents an analysis of the mortality patterns of people who become world leaders. Using information in the public domain, we identified 261 world leaders who died between 1965 and 1996. Of these, 118 died while in office, 44% violently, often by assassination. Of the 143 leaders who died after leaving office, 11% died violently. The violent deaths occurred worldwide but most frequently in the Middle East/South Asia and sub-Saharan Africa regions. The most frequent natural causes of death among world leaders were heart disease, cancer, and stroke. Mortality patterns reveal that the longevity of those leaders who died of natural causes could have been predicted by U.S. life tables. This study suggests that world leaders are neither biologically "tougher" nor more vulnerable to disease than others; however, their odds of dying violently while in office are high.