McGill H C, McMahan C A, Tracy R E, Oalmann M C, Cornhill J F, Herderick E E, Strong J P
University of Texas Health Science Center at San Antonio, USA.
Arterioscler Thromb Vasc Biol. 1998 Jul;18(7):1108-18. doi: 10.1161/01.atv.18.7.1108.
In a cooperative multicenter study, the Pathobiological Determinants of Atherosclerosis in Youth, we measured atherosclerosis of the aorta and right coronary artery (RCA) in 2403 black and white men and women 15 through 34 years of age who died of external causes and were autopsied in forensic laboratories. We measured the diameter of the opened, flattened, and fixed RCA and the diameter, intimal thickness, intimal cross-sectional area, medial thickness, and medial cross-sectional area of the pressure-perfused, fixed left anterior descending (LAD) coronary artery. Using the ratio of intimal thickness to outer diameter of the small renal arteries to predict mean arterial pressure during life, we classified the cases as normotensive (mean arterial pressure < 110 mm Hg) or hypertensive (mean arterial pressure > or = 110 mm Hg). The prevalence of hypertension by age, sex, and race corresponded closely with that measured in a survey of the living population. Hypertension had little or no effect on fatty streaks. Hypertension was associated with more extensive raised lesions in the abdominal aortas and RCAs of blacks > 20 years of age and in the RCAs of whites > 25 years of age. At all ages, women had less extensive raised lesions in the RCAs than did men, but the effect of hypertension on raised lesions was similar to that in men. Adjustment for serum lipoprotein cholesterol levels and smoking in a subset of cases yielded results similar to those obtained without adjustment. Hypertension was associated with larger diameters of the RCA and LAD coronary artery and with larger cross-sectional intimal and medial areas of the LAD coronary artery. Hypertension augments atherosclerosis in both men and women primarily by accelerating the conversion of fatty streaks to raised lesions beginning in the third decade of life, and the effect of hypertension increases with age.
在一项合作多中心研究“青年动脉粥样硬化的病理生物学决定因素”中，我们测量了2403名15至34岁因外因死亡并在法医实验室接受尸检的黑人和白人男性及女性的主动脉和右冠状动脉（RCA）的动脉粥样硬化情况。我们测量了切开、展平并固定后的RCA的直径，以及经压力灌注、固定后的左前降支（LAD）冠状动脉的直径、内膜厚度、内膜横截面积、中膜厚度和中膜横截面积。利用小肾动脉内膜厚度与外径的比值来预测生前的平均动脉压，我们将这些病例分为血压正常（平均动脉压<110 mmHg）或高血压（平均动脉压≥110 mmHg）。按年龄、性别和种族划分的高血压患病率与对现有人口调查所测得的患病率密切相符。高血压对脂纹几乎没有影响。高血压与20岁以上黑人的腹主动脉和RCA以及25岁以上白人的RCA中更广泛的隆起病变有关。在所有年龄段，女性RCA中的隆起病变都比男性少，但高血压对隆起病变的影响与男性相似。对一部分病例的血清脂蛋白胆固醇水平和吸烟情况进行调整后得到的结果与未调整时相似。高血压与RCA和LAD冠状动脉的较大直径以及LAD冠状动脉较大的内膜和中膜横截面积有关。高血压主要通过加速脂纹在生命第三个十年开始向隆起病变的转化来加重男性和女性的动脉粥样硬化，且高血压的影响随年龄增加而增大。
