The Natural History of aortic and coronary atherosclerosis in colombia evaluated by necropsy examination

Abstract

Summary A total of 626 aortas and 379 coronary artery sets were collected from consecutive autopsies of persons aged 1-79 years in a large charity hospital and the medico-legal office in Cali, Colombia. Atherosclerotic lesions were estimated visually in terms of the percentage of the intimal surface of each arterial segment involved by the various types of atherosclerotic lesions. Fatty streaks develop in the aorta of Colombian males and females to a greater extent than the New Orleans white males and females, and in lesser degree than in New Orleans Negro males and females. In spite of this initial change the formation of fibrous plaques is observed in lesser extent in the Colombian population than in the New Orleans group, but at slightly larger proportion than the Guatemalans and the Bantu. The differences with the New Orleans cases are more striking when the more severe atherosclerotic lesions are considered (fibrous plaques, complicated and calcified lesions). When the "severity index" of the abdominal aorta in the Colombian group is compared with the New Orleans cases, a clear stratification of the groups is observed with New Orleans white males and females showing the highest values and the Colombian cases exhibiting the least severe involvement. Atherosclerotic lesions in the coronary arteries are also present in the Colombian cases but the extent and severity of such lesions is lesser in degree than for the aortas when the same age groups and sex are considered. Coronary artery lesions were compared between Colombian and New Orleans white and negro males and again the same pattern as with the aortic atherosclerotic lesions was observed. Aortic and coronary artery atherosclerotic lesions were less severe in Colombian females than in males at any age group studied. These results show also that the cause of death should be taken into consideration for the purpose of geographic comparisons of pathological observations of necropsy material for the purpose of the study of atherosclerotic lesions. Cases dying of "atherosclerotic heart disease" or because of other diseases considered to aggravate atherosclerosis should be excluded for this comparison. The product-moment correlation coefficient was calculated for aortic with coronary atherosclerotic lesions in 427 cases, where both the aorta and coronary arteries were studied. A weak but positive correlation was found between most of the lesion measures compared. The highest values were for aortic total surface with coronary total surface ( r 0.52), aortic and coronary fibrous plaques ( r 0.51) and aortic severity index with coronary total surface (r 0.59) and with coronary fibrous plaques ( r 0.54). These data on aortic and coronary atherosclerosis are inconsistent with the extremely low rate of arteriosclerotic heart disease attributed to Colombia on the basis of vital statistics data, and suggest that this rate, at least for Cali, should be higher than presently reported, but lower than for the North American whites.