The Natural History of Coronary Atherosclerosis

¹ Department of Medicine, Sarojini Naidu Medical College

The natural history of coronary atherosclerosis has been reconstructed from data gathered from 200 consecutive medicolegal necropsies. Coronary atherosclerosis in men commences in the second decade in the form of fatty spots which are most frequent in the anterior descending branch of the left coronary artery. The earliest evidence of atherosclerosis in women was seen in the third decade. The atherosclerotic process does not progress beyond grade I in the second decade. The extent and severity of atherosclerosis increases progressively with age, without a terminal decline in the mean atherosclerotic index. Atherosclerosis is present in all cases above 40 years. Fibrous plaques are first noticed in the fourth decade. Complicated lesions are seen for the first time in the fifth decade. The narrowing index of the coronary arteries also progresses with age from the fourth decade onwards, no significant narrowing being detectable earlier. The process of atherosclerosis is consistently more advanced in the anterior descending branch of the left coronary artery than in the circumflex branch or the right coronary artery. The extent and severity of atherosclerosis is less in women than in the men in each decade and the process commences a decade later.