(Circulation. 2000;102:374.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Association of Coronary Heart Disease Risk Factors With Microscopic Qualities of Coronary Atherosclerosis in Youth
From the Department of Pathology, The University of Texas Health Science Center at San Antonio (H.C.M., C.A.M.) and Southwest Foundation for Biomedical Research (H.C.M.), San Antonio, Tex; the Department of Pathology, Louisiana State University Medical Center, New Orleans (A.Z.W., R.E.T., G.T.M., J.P.S.); and the Biomedical Engineering Center, Ohio State University, Columbus (E.E.H.).
Correspondence to Henry C. McGill, Jr, MD, Southwest Foundation for Biomedical Research, PO Box 760549, San Antonio, TX 78245-0549. E-mail jstron{at}lsumc.edu
Background—This study examined whether atherosclerosis in young people is associated with the risk factors for clinical coronary heart disease (CHD).
Methods and Results—Histological sections of left
anterior descending coronary arteries (LADs) from 760 autopsied
15- to 34-year-old victims of accidents, homicides, and suicides were
graded according to the American Heart Association (AHA) system and
computerized morphometry. Risk factors (dyslipoproteinemia, smoking,
hypertension, obesity, impaired glucose tolerance) were assessed by
postmortem measurements. Approximately 2% of 15- to 19-year-old men
and 20% of 30- to 34-year-old men had AHA grade 4 or 5 (advanced)
lesions. No 15- to 19-year-old women had grade 4 or 5 lesions; 8% of
30- to 34-year-old women had such lesions. Approximately 19% of 30- to
34-year-old men and 8% of 30- to 34-year-old women had atherosclerotic
stenosis 
40% in the LAD. AHA grade 2 or 3 lesions (fatty
streaks), grade 4 or 5 lesions, and stenosis 40% were
associated with non-HDL cholesterol 4.14 mmol/L (160
mg/dL). AHA grade 2 or 3 lesions were associated with HDL
cholesterol <0.91 mmol/L (35 mg/dL) and smoking. AHA
grade 4 or 5 lesions were associated with obesity (body mass index 30
kg/m2) and hypertension (mean arterial pressure
110 mm Hg).
Conclusions—Young Americans have a high prevalence of advanced atherosclerotic coronary artery plaques with qualities indicating vulnerability to rupture. Early atherosclerosis is influenced by the risk factors for clinical CHD. Long-range prevention of CHD must begin in adolescence or young adulthood.
Key Words: atherosclerosis • coronary disease • risk factors • youth
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