Epidemiology of ischemic heart disease among white males: III. Role of coronary atherosclerosis and clot formation in patients with ischemic heart disease

Abstract

1. 1. An epidemiologic study of ischemic heart disease among white males in a necropsy population showed that the basic pathology of the disease apparently is changing. Ischemic heart disease patients who died from 1935–1944 were found to have significantly more severe coronary atherosclerotic blockage than those who died from 1945–1955. Also, there was a suggestion that coronary artery clots among patients in the 40–49 and 50–59 year age groups were less prevalent in 1935–1944 than in 1945–1955. 2. 2. When the coronary arteries of ischemic heart disease patients were compared with those of a control group of accident and cancer patients, the former were found to have significantly more severe coronary atherosclerotic blockage and more coronary clots. 3. 3. There was no difference in the severity of coronary atherosclerotic blockage among hypertensive and nonhypertensive ischemic heart disease patients. However, the hypertensive patients developed fewer coronary clots than the nonhypertensive. 4. 4. Body weight at the time of death had no significant relationship to the severity of coronary atherosclerotic blockage among ischemic heart disease patients. However, the body weight did have a strikingly significant relation to coronary clots: 62 per cent of overweight patients had clots; 48 per cent of average-weight patients had clots; and only 27 per cent of underweight patients had clots. 5. 5. Indirect evidence of a possible coagulation defect among ischemic heart disease patients was found. “Extracardiac” clots were found in 34 per cent of these patients, in contrast to 21 per cent of cancer patients. However, ischemic heart disease patients with coronary clots did not have significantly more “extracardiac” clots than those without coronary clots. 6. 6. Data were presented which suggest that ischemic heart disease among diabetic patients differs from ischemic heart disease among the nondiabetic. Ischemic heart disease patients with concomitant diabetes mellitus had significantly more severe coronary atherosclerotic blockage than those without diabetes. On the other hand, only 37 per cent of the diabetics in contrast to 53 per cent of the nondiabetics with ischemic heart disease had coronary artery clots.