PREDICTORS OF MYOCARDIAL LESIONS IN MEN WITH MINIMAL CORONARY ATHEROSCLEROSIS AT AUTOPSY - THE HONOLULU HEART PROGRAM

Some cardiovascular risk factors are associated with clinical coronary heart disease but not with autopsy evidence of coronary atheroscleros is. To determine whether these risk factors might operate through mech anisms other than atherosclerosis, we examined associations between ca rdiovascular risk factors and subsequent intramural myocardial lesions assessed by protocol autopsy between 1965 and 1984 in 120 Japanese-Am erican men from the Honolulu Heart Program who had minimal coronary at herosclerosis (American Heart Association (AHA) panel score < 3 on sca le of 1 to 7). Age-adjusted Prevalence of myocardial lesions was relat ed to smoking status (P < 0.01), as well as amount, duration, and pack -years of smoking (P < 0.03). In a multiple logistic model, smoking (2 0 pack-years) was directly associated and fsh intake (greater than or equal to 2 times/wk) was inversely associated with myocardial lesions independently of age, cholesterol, systolic blood pressure, body mass index, alcohol, diabetes, total calories, and animal protein intake (o dds ratio (OR) = 1.5, 95% confidence intervals (CI) = 1.1 to 2.0 and O R = 0.35, 95% CI = 0.2 to 0.9, respectively). The protective effect of fish intake was most evident among men who did not have hypertension at baseline. Indices of obesity, body fat distribution, and physical a ctivity and levels of triglyceride and alcohol intake were not associa ted with myocardial lesions. Thus, the adverse effects of smoking and the protective effects of fish consumption may extend to individuals r elatively free of coronary atherosclerosis, possibly through hemostati c mechanisms or effects on small intramural arteries.