Risk factors and atherosclerotic lesions. A review of autopsy studies.

Abstract

This review assesses the current status of knowledge concerning the relationship of risk factors to atherosclerotic lesions. Risk factors for atherosclerotic lesions per se need not necessarily be identical to those related to clinically overt coronary heart disease (CHD). This review is based on 1) autopsy studies where information on risk factors was gathered In a retrospective fashion; and 2) autopsy studies where information on risk fetors was gathered prospectively. In spite of differences in study designs and grading methods among the studies, the general findings were similar. Elevated serum cholesterol and blood pressure are positively and significantly related to atherosclerotic lesions. High density llpoprotein cholesterol Is inversely related to coronary and probably also to cerebral atherosclerosis. Almost all studies Indicate a significant association between cigarette smoking and degree of aortic atherosclerosis; a positive relationship between smoking and coronary atherosclerosis Is found In many, but not all, studies. In most studies no consistent association was found between obesity or physical activity and the degree of atherosclerosis. Data from the Community Pathology Study in New Orleans indicate that the average extent of coronary atherosclerosis in a population may be subject to changes within a relatively short period of time; these changes might be expected to parallel changes In risk factors In the population. (Arteriosclerosis 3:187-198, May/June 1983) E pidemiologic studies of living populations have identified personal attributes associated with increased risk of developing coronary heart disease (CHD). The clinical endpoints for CHD (myocardial infarction, sudden death due to coronary thrombosis, and angina pectoris) are the result of a combination of factors, including the amount and distribution of coronary atherosclerosis, mechanisms related to the occlusive episode, the size and workload of the heart, and sequelae such as cardiac arrhythmias and myocardial failure. The close relationship between severity and extent of coronary atherosclerosis and the development fo CHD is now almost universally accepted; nevertheless, it is important to establish whether risk factors for clinically overt CHD are also related to the development of atherosclerosis per se.1 Risk factors for CHD could be associated This research was supported in part by Grant HL-08974 from the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Public Health Service.Address for reprints: Dr. Jack P. Strong, Department of Pathology, Louisiana State University Medical Center, 1901 Perdido Street, New Orleans, Louisiana 70112. 'Received December 11, 1982; revision accepted February 8, 1983. with the basic development of the underlying arterial lesions or with the complications of lesions, such as thrombosis, hemorrhage, rupture of plaques, and embolism. Risk factors could also act directly on the myocardium and its conduction system, not on the underlying arterial lesions. The detection ...

Coronary artery and abdominal aortic calcification are associated with cardiovascular disease in type 2 diabetes

“…Differences in relationships of risk factors, and in particular, cigarette smoking, to the extent of atherosclerosis in different vascular beds has been previously suggested [29,30] and this notion gains further support from the findings in this study. Identifying and understanding these different risk factor-vascular pathology location interactions may provide insight into basic mechanisms of atherosclerosis and suggest potential strategies for more focused interventions for vascular disease at specific sites.…”

Asymptomatic hyperglycaemia is associated with increased intimal plus medial thickness of the carotid artery

“…The atherosclerotic processes occurring in the coronary arteries, extracranial carotid arteries, and peripheral arteries in the legs appear to be pathologically identical [42]. Also, a correlation between coronary and carotid atherosclerosis has been noted in previous autopsy studies [43,44]. The present study clearly demonstrates that asymptomatic hyperglycaemic non-diabetic subjects had increased carotid arterial wall thickness, comparable to that of agematched diabetic patients.…”

Lower insulin sensitivity as an independent risk factor for carotid wall thickening in normotensive, non-diabetic, non-smoking normal weight and obese premenopausal women

“…6 Moreover, a higher intima ± media thickness of extracranial carotid arteries has been related to higher prevalence of coronary heart disease 3,4 and transient ischaemic attack, 5 and a relationship between common carotid intima ± media thickness and extent and severity of atherosclerosis in coronary arteries has also been shown in ultrasound and autopsy studies. 2,30,31 Since insulin resistance has been found in patients with CHD, 32 our results seem to reinforce the hypothesis that insulin resistance may have a direct role in accelerating the development of coronary atherosclerosis.…”