Risk factors and raised atherosclerotic lesions in coronary and cerebral arteries. Statistical analysis from the Oslo study.

Abstract

In 1972-1973, about 16,200 men living In Oslo, aged 40 to 49 years, were examined for cardiovascular disease, and had a number of coronary risk factors measured. This report gives the results of 129 autopsied cases with regard to the association between raised atherosclerotic lesions In coronary and cerebral arteries and various coronary risk factors. For coronary raised lesions, the high density llpoproteln (HDL) cholesterol ratio was the most significant risk factor. Systolic blood pressure and total serum cholesterol were also significantly associated. Physical activity at work and at leisure, nonfastlng trlglycerldes, and cigarette smoking did not show a significant association with coronary artery raised lesions. The association between total serum cholesterol and systolic blood pressure Indicates that total serum cholesterol may be more Important than systolic blood pressure In the synerglsm affecting the development of coronary atherosclerosis. For cerebral artery raised lesions, blood pressure was the most important risk factor, even though serum cholesterol was highly associated with the lesions. The Interaction analysis also suggested that blood pressure was more Important than serum cholesterol In the synerglsm. (Arteriosclerosis 1981; 1:250-256) N umerous epidemiological reports have demonstrated an association between certain risk factors and coronary heart disease (CHD). Since coronary atherosclerosis as a rule forms the basis for the development of CHD, the assumption has been made that risk factors for CHD are identical with those for coronary atherosclerosis. This assumption may be true for some risk factors but not necessarily for all of them. Risk factors could also act directly on the myocardium and its conduction system and thus contribute to the development of clinical disease.Since quantitative estimates of atherosclerosis are difficult to obtain in living persons, most information about risk factors has been obtained from retrospective autopsy studies. 1 More recently, several prospective studies have been initiated that are characterized by careful documentation of certain risk factors during life and standardized evaluation of atherosclerotic lesions at autopsy. 2 " 6 These studies have shown significant relationships between levels of serum cholesterol, blood pressure (BP), other selected risk factors, and the extent of coronary atherosclerosis. This report analyzes in more detail the multivariate relationship between risk factors and raised atherosclerotic lesions in the coronary and cerebral arteries of the population in the Oslo study. 27

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.…”

Increasing Severity of Cardiovascular Risk Factors With Increasing Middle Cerebral Artery Stenotic Involvement in Type 2 Diabetic Chinese Patients With Asymptomatic Cerebrovascular Disease

“…Blood pressure is a major predictor of hemorrhagic and atherogenic forms of stroke (4,17). Hypertension has been reported to be associated with more severe atherosclerosis in the inter-but not the extracranial cerebral vessels, and this is supported by a number of studies (21,22). In the current study, both systolic blood pressure (despite confounding by treatment) and the proportion of subjects with hypertension were significantly elevated in subjects with MCA stenosis, and both were independent predictors for the increasing MCA stenotic vascular involvement.…”

George Lyman Duff memorial lecture. Persistent problems in the pathogenesis of atherosclerosis.

“…Only recently has direct evidence bearing on this question been available. 42 The Oslo Study 43 obtained antemortem measures of serum cholesterol and postmortem measures of atherosclerosis in over 200 men 40 to 56 years of age. There was a linear relationship of serum cholesterol to advanced coronary atherosclerosis, with a correlation coefficient of about 0.4.…”

“…The Oslo Study showed a strong relationship of blood pressure to arterial lesions in 40-to 56-yearold men. 43 It is widely believed that hypertension augments atherosclerosis directly by way of increased pressure, but some investigators have suggested that renin (or a related vasoactive hormone) may be an independent atherogenic factor. The failure of antihypertensive drug therapy to reduce the incidence of coronary heart disease as much as it reduces other hypertensive sequelae 51 has encouraged the idea that some component of hypertensive pathophysiology other than blood pressure may be atherogenic.…”