Development of atherosclerosis over a 25 year period: an epidemiological autopsy study in males of 11 towns

We conducted an analysis of the data from two epidemiological autopsy studi es of atherosclerosis in men aged 20-59 years in 1963-66 (the first study, 7470 cases) and in 1985-88 (the second study, 9600 cases). The investigatio ns were performed in accordance with a special program of the World Health Organization in 11 town populations: Ashkhabad (Turkmenistan), Bishkek (Kir gizstan), Irkutsk and Yakutsk (Russia), Malmo (Sweden), Prague (Czech Repub lic), Riga (Latvia), Tallinn and Tartu (Estonia), and Kharkov and Yalta (Uk raine). Native and non-native populations were studied separately in Ashkha bad, Bishkek, and Yakutsk. Atherosclerosis was studied by the visual morpho metrical method in the descending thoracic aorta, abdominal aorta and three main coronary arteries. In each vessel the prevalence and extent (percent of intimal surface) of fatty streaks, fibrous plaques, complicated, calcifi ed and also raised lesions (all lesions except fatty streaks) were determin ed. Coronary stenosis was estimated in arteries as narrowed by more than 50 %. Accelerated development of coronary atherosclerosis, especially in the 4 0-59 year age group, was noted in the second study in the male populations of most towns except Prague and Malmo. In Prague the extent of raised lesio ns in coronary arteries was practically the same in both studies, in Malmo it decreased in the second study. Aortic atherosclerosis also accelerated t he rate of progression in all towns except Prague, where significant differ ences were not observed between the studies. Accelerated development of ath erosclerosis in male populations from towns of Asia was combined with an in crease of fatty streaks in all vessels, while in European populations it wa s not so obvious. In the native populations of Ashkhabad, Bishkek and Yakut sk, atherosclerosis was much less than in non-natives in both studies. In n atives of these towns, accelerated development of atherosclerosis begins on ly from 40 years, in non-natives from 30. For the second study, there was t ypically an increase of the prevalence and extent of calcified lesions that were combined with an increased prevalence of coronary stenosis in all tow ns. The average percentage of stenosis in the coronary left anterior descen ding artery for men of 40-59 years of age was 12% in the first study and 24 .9% in the second; for the coronary right artery, 7.4 and 13.8%, respective ly. In accordance with findings of more severe atherosclerosis in males in most towns in the second study, there was an increase in the frequency of d eath from coronary heart disease in the second study in these towns. The da ta of this study indicate that the development of atherosclerosis in human populations may change very much in the course of the life of one generatio n. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.