Risk Factors and Atherosclerotic Lesions. A Review of Autopsy Studies

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 risk factors was gathered in a retrospective fashion; and 2) autopsy studies where information on risk factors 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 lipoprotein 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 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.