Pathological and Epidemiological Study of Coronary Atherosclerosis in Autopsy Subjects of Hisayama Town

目的：本研究的目的是利用日本普通人群的尸检对象，分别调查男性和女性冠状动脉粥样硬化的危险因素，并检验冠状动脉粥样硬化的病理评估的有效性。方法：本研究以1988年接受大规模体检并于1996年死亡的233例久山市居民为研究对象。心外膜冠状动脉分为14个节段，每个节段狭窄程度最大的部位进行组织学检查。通过对14例标本进行冠状动脉粥样硬化病变特征和狭窄率的测定，对冠状动脉粥样硬化进行整体评价，分为6级。分析的危险因素包括年龄、收缩压和舒张压、血清总胆固醇、高密度脂蛋白-胆固醇、血红蛋白A1C、吸烟和饮酒习惯、体重指数和腰臀比。结果：男性冠状动脉粥样硬化程度与年龄、收缩压、血清总胆固醇、血红蛋白A_1c显著相关，女性年龄、收缩压、腰臀比与冠状动脉粥样硬化程度显著相关。结论：1)以病理检查为基础的全面评估有助于探讨冠状动脉粥样硬化的危险因素。2)男性和女性的危险因素略有不同，尤其是代谢方面。

PURPOSE : The aims of this study were to investigate risk factors for coronary atherosclerosis in men and women, respectively, using autopsy subjects of Japanese general population, and to examine the validity of pathological assessments for coronary atherosclerosis.METHODS : Two hundred and thirty three cases in Hisayama residents over 40 years of age, who underwent a mass medical examination in 1988 and an autopsy at death by 1996, were subjected to the study. Epicardial coronary arteries were divided into 14 segments and the most narrowed site in each segment was sectioned for histological examinations. The coronary atherosclerosis was globally assessed by characterizing the atherosclerotic lesion and measuring the stenotic ratio in the 14 specimens, and graded into 6 grades. Risk factors analyzed were age, systolic and diastolic blood pressures, serum total cholesterol, HDL-cholesterol, hemoglobin A1C, smoking and drinking habits, body mass index and waist to hip ratio. Multiple regression analysis was used for statistical analysis.RESULTS : There were significant correlations between the grade of coronary atherosclerosis and age, systolic blood pressure, serum total cholesterol and hemoglobin A_1c in men, and age, systolic blood pressure and waist to hip ratio in women.CONCLUSIONS : 1) The global assessment based on pathological examination is useful to investigate risk factors for coronary atherosclerosis. 2) The risk factors are slightly different between men and women, especially in metabolic aspects.