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KMID : 0377619610010080875
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Korean Jungang Medical Journal
1961 Volume.1 No. 8 p.875 ~ p.898
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Quantitative Estimation of Aortic Atherosclerosis of Koreans
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Abstract
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The incidence of disease contributable to atherosclerosis has been recognized to be different considerably among the peoples of different geographical localities. It is generally understood that diseases caused by atherosclerosis are not common among Koreans. At National Medical Center in Korea not a single case of myocardial infarction due to coronary atherosclerosis was found among 534 consecutive autopsies in a period of approx. 3years, 1958 to 1961. Frequently dietary habits and serum lipids such as cholesterol and lipoproteins of the peoples have been considered to be important relation to the geographic difference. However, no reliable systematic comparison of the extent and severity of atherosclerosis of the vessels was available due to lack of universally acceptable objective method of quantitative estimation until Gore & Tejada in 1957 and Holman et al: in 1958 introduced respectively a method of quantitative estimation of aortic atherosclerosis.
This report is based on a pathological study by the method of Holman et al. on 429 aortas including 70 cases of neonatal infants under 1 month of age from consecutive autopsies.
Lesions -were graded into 3 types: Fatty streaks, fibrous plaques, and, complicated lesions (ulceration, hemorrhage, thrombosis and calcification). Percentages of surface involved by the.3.types of lesions are grouped into 9 categories:0.%, < 1%,1-5%, 6-10%, 11-20%,21-30%,31-50%,51-75%,76-100%.
Aorta was divided into 4 anatomical regions: ascending, arch, thoracic and. abdominal portions.
Entire aorta and each anatomical region were evaluated into 9 categories by each of 3 types of lesions, both before and after Sudan IV staining.. The following results were obtained.
1. Sudanophilic deposits were found in the aortas as young as 2 months of age, and in all individuals after the age of 3 years. Frequency of incidence between one month and under 1 year of age was 62%. Supravalvular portion of ascending aorta, every openings of branching vessels, and posterior surface of thoracic and abdominal aorta revealed earliest and most frequent involvement. Some of these early lipid deposits seemed to disappear spontaneously. Fatty streaks increased rapidly between 13 and 18 years of age and again between 48 and 53 years of age, suggesting influence by alterations of hormonal activity at puberty and climacterium.
2. Fibrous plaques began to appear at the age of 13 years with low value of 0.1%, and showed significant rise from 0.9 % to 4.5% between 28 to 33 years of age and again from 6°o to 14.8% between 53 to 58 years of age. They paralleled the development of fatty streaks, but lagged about 15 years. By 60 years of age, about 15% of fatty streaks had been converted into fibrous plaques. Frequency of incidence was 8%, 30%, 79%, 88%, and IOU 15 at the ages of 13, 23. 33, 43, and beyond .50 in the given order.
3. Complicated lesions began to appear at the age of 38 years with minor value of 0.1%, and increased slowly to about 1 % by 60 years of age. Frequency of incidence was 10%, 40% and 70 to 80% at the ages of 38, 53 and beyond 58 in the given order.
4 The extent of fatty streaks by anatomic regions was most severe in the abdominal aorta in the order of abdominal, thoracic, ascending. and arch after. the age of 13 years
But before the age of 13 years the ascending aorta was most severely involved and after the age of 48 it approached to abdominal aorta in the degree of extent.
5, Fatty steaks, fibrous plaques and complicated lesions developed successively, suggesting the sequential occurrence.
6 Comparison by sex was not significant in the statistical meaning, probably due to lack of sufficient numbers of cases.
7. Secondary hypertension observed under the age of 35 years increased greatly both the extent of. fatty streaks and fibrous plaques, and gave much more influence to the younger age groups. The fibrous intimal thickening without lipid deposits was characteristic and different- from the, ordinary: fibrous - plagues, in atherosclerosis.
8. Two types of strange intimal. changes-. in the form-of multiple, closely spaced, transverse striae were observed. One, seemed to have correlation with obstruction, of ductus, Botalli, running obliquely` from the scar of lig:, arteiosum. The other increased in numbers during fixation and appeared more frequently. in the abdominal aorta, rarely showing- subsequent hypertrophy. and stricture. Bath. of them seemed not to be related with atherogenesis and are found rather frequently until the age of 50.
9. Fibrous plaques were formed mainly on the basis of fatty streaks but occasionally definitely not related with lipid deposits, suggesting different factors controlling the intimal fibrosis.
By application of, gross Sudan IV´ staining on the aorta, fatty streaks, were more accurately detected both n the incidence and extent, particularly. in the incidence in infants
Finally when author´s data on Koreans. are compared with those on American
whites by Holman et, al. and by Hirst et al., the most significant difference is that fatty streaks developed to almost same extent in both populations by;.,a-out 4U years of age, but after that fibrous plaques increased much more precipitously in whites than in oreans.
This fact supports the view that fatty streaks are not so markedly influenced, by race, fat intake and other environmental factors, and different factors may be responsible in the progression of fatty streaks and fibrous plaques.
The atherosclerotic patterns in the anatomic regions were completely similar! in both populations, suggesting unknown common intrinsic and extrinsic factors, in aortic wall itself.
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KEYWORD
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