Nephrosclerosis, glycohemoglobin, cholesterol, and smoking in subjects dying of coronary heart disease.

Subjects dying of coronary heart disease (CHD) were compared with subjects in a control (basal) group in two series of forensic autopsies. Serum cholesterol assessed in postmortem heart blood was significantly greater in the CHD than in the basal group. CHD subjects were smokers more often than basal subjects, as determined from postmortem serum thiocyanate levels, but the statistical significance is ambiguous (P < 0.06). After exclusion of overt diabetics, a stepwise increase in the percentage of subjects with CHD was observed throughout the normal range for glycohemoglobin. Fibroplasia of small renal arteries, the most reliable postmortem proxy for hypertension, did not differ between CHD and basal groups. These results suggest that young (mean age 49.2 yr) black and white men and women classified from autopsy findings as having CHD as cause of death are often not hypertensive, but instead tend to be hyperlipidemic and glucose intolerant. A surprising result was that arteriolar hyalinization and arterial fibroplasia of the renal cortex often failed to parallel each other between groups of subjects. This was true in comparisons between black and white, male and female, blood cholesterol and glycohemoglobin groupings, and between CHD and basal subjects. This outcome suggests that hyalinization of renal arterioles is an especially reliable marker for CHD and that this association may not be mediated entirely through high blood pressure.