A Study of Coronary Heart Disease in Young Men

To study metabolic factors in the genesis of coronary heart disease in previously healthy young adults, 24 men (aged 23 to 49 years) who had recovered from proven myocardial infarction were compared with an age-matched series of 20 healthy subjects-10 business and professional men and 10 prisoners. Both series averaged 10% above ideal body weight. The patients were shorter, were heavier smokers, and had a high familial incidence (70%) of coronary heart disease. The controls had more familial diabetes. Oral glucose tolerance tests without and with cortisone showed higher peak blood sugar levels and delayed return in the patients. Four patients were found to have fasting serum triglycerides above 300 mg% and were placed in a separate category of essential hyperlipidemia. In the remaining 20 patients, serum cholesterol and triglycerides in combination were higher than in the controls, together with elevation of pre-β-lipoproteins. α 1 -Lipoprotein was decreased. Mean postheparin lipolytic activity was slightly less in the patients-in the lower part of the normal range. In the combined series of patients and control subjects, the relative body weight showed significant correlations-directly with the 1-hour blood sugar level in the glucose tolerance test and with the fasting serum triglyceride level, and inversely with the α 1 -lipoprotein. The relative body weight did not show a significant correlation with the serum cholesterol level. A set of 10 characteristics and biochemical variables, referred to in preceding paragraphs, was found to discriminate well between the patients and their controls. The total incidence of abnormal findings was high among the patients (mean, 4.9 per man) and low among the controls (mean, 1.9 per man), but the positive items were grouped in many different ways in individuals. Analysis of the data suggests that over-nutrition and heavy smoking interact with hereditary factors in certain individuals to accelerate the progress of coronary atherosclerosis. Since individuals who exhibit many of the criteria indicative of increased risk are not uncommon in our population, their identification as candidates for coronary heart disease early in life is a significant public health problem.