Pathology of coronary arteriosclerosis ∗

Abstract

The heart and coronary arteries from 1,500 American soldiers killed in action in Korea and from 1,500 routine autopsies in the Arlington Community Hospital, Arlington, Virginia, have been studied to determine the pathogenesis and progression of coronary arteriosclerosis. In addition, autopsy material from 114 cases of Japanese natives was also available. Certain observations were also made from 600 autopsies performed at the Board of Health Laboratory, Gorgas Hospital, Ancon, Canal Zone. The probable alteration in the process of natural diffusion within the arterial wall, primarily occurring within the intima, seems to offer an important clue to the fundamental pathogenesis of atherosclerosis. Sites of predilection for the lesion seem to be initiated at points of increased hemodynamic stress but are undoubtedly complicated by other intrinsic anatomic and physiologic factors which exert their influence in rather dramatic contrast between the two sexes and, in the case of the female subject, at different ages relative to the activity of her reproductive period. This observation, regarded as factual by most investigators, is significant and challenging. Points of hemodynamic stress in the arterial system of the male and female subject should, in the absence of predilection for atherosclerotic lesions in the two sexes, coincide. Eventually they do, but for puzzling reasons the site of predilection in the female subject does not exhibit clinically significant atherosclerotic lesions during her active reproductive period, a time during which she may have one to several episodes of hypercholesteremia associated with pregnancy. Arteriosclerotic lesions apparently accelerate with the decline in the reproductive period. This seems to be the single constant among the many variables observed in the pathogenesis of coronary arteriosclerosis. Statistics are presented pointing out the differences in the incidence of coronary disease between the white American, the American and African Negroes, and the Japanese. The distribution of sudanophilic material in the coronary arteries of the Japanese is offered as one of the possible morphologic expressions of dietary differences among the races. The fact that atherosclerotic lesions in the epicardial segments of the coronary arteries cause significant luminal narrowing in a majority of young white adult American male subjects examined at postmortem, regardless of the cause of death, brings to medical attention one of the most serious cardiovascular problems in the United States today.