Developmental Patterns of Coronary and Aortic Atherosclerosis in Young Negroes of Haiti and the United States

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Abstract
Hearts and aortas from 177 routine autopsies of Haitian and American Negroes below age 30 were examined, their individual age, sex and country of origin unkown to the pathologist. Gross grading of degrees of atheromatous involvement disclosed that the previously observed greater incidence and severity of coronary artery atherosclerosis among adults of the US as compared to the Haitians does extend down in age at least to adolescence. Yet grades of the aortas of the same subjects showed little or no quantitative difference between these genetically similar populations. Microscopic studies of the coronary vessels revealed a general progression with age of proliferative thickening of the intima, fraying and fragmentation of the elastica interna beginning in early childhood. These microscopic changes showed a similar difference in degree between subjects of the primitive and of the American civilization, paralleling the gross findings in the adults. Their significance remains uncertain but if they do represent early, non-lipid phases of atherogenesis, confirma-tion of such a population dissimilarity should direct investigative interest toward the early years of life. This apparent predisposition of the American group to coronary but not to aortic atherosclerosis suggests the importance of factors other than dietary fats in the etiology of coronary heart disease. Observed differences both among individuals and contrasting civilizations in the selective involvement of the diverse vascular beds of the body may afford a promising clue.