Coronary Atherosclerosis in Middle‐aged and Elderly Finnish Men. Pathological Study of Coronary Arteries in Violent and Sudden Coronary Deaths

The occurrence of coronary atherosclerosis was studied in 271 Finnish men aged 40 years or more, of whom 143 had met a violent death and 128 had died suddenly of coronary heart disease (CHD). A coronary stenosis was found in half of the men who had met a violent death and were over 50 years old. The occurrence of the stenosis was closely related to the extent of the raised atherosclerotic lesions (RL) and to the degree of the plaque calcification. In 60% of the sudden deaths (SD) the extent of RL did not differ from that in violent deaths. The stenosis patterns in these SD were similar to those in living CHD patients. The remaining SD had an extreme stage of coronary artery involvement, i.e. extensive plaques with severe obstructive changes. The men in this study series of violent deaths born in various parts of the country did not differ with regard to the extent of RL. Within the upper half of the RL area range, men born in the east were consistently shown to have a stenosis, while the occurrence in men from the western counties was more random. Severe stages of coronary artery involvement tended to be more frequent in SD patients born in the east than in those born in the west. It was concluded that there are probably two background factors concerning the difference in CHD mortality between men in western and eastern Finland: 1) the tendency to form a stenosis by the advancement of RL extent is stronger, and 2) the progressive development of coronary artery disease in CHD patients is more frequent in the east than the west.