Early atherosclerosis declines in autopsy study

In 1953 a report from the Armed Forces Institute of Pathology reported a 77% prevalence of coronary atherosclerosis among US soldiers killed in the Korean War. This revolutionary study demonstrated that atherosclerosis was present in a large number of young patients without clinical evidence of heart disease. A new study aimed to estimate the current prevalence of coronary and aortic atherosclerosis in the US armed forces, to assess the impact of risk factor reduction and lifestyle measures.

This was a cross-sectional study of all US service members who died of combat or unintentional injuries between October 2001 and August 2011. Coronary atherosclerosis severity was classified as: minimal (fatty streaking only), moderate (10%–49% luminal narrowing of 1 or more vessels), and severe (>49% narrowing of 1 or more vessels).

Of the 3832 service members included, the mean age was 25.9 years and 98.3% were male. 8.5% showed evidence of any coronary atherosclerosis, and severe coronary atherosclerosis was found in only 2.3%. Those with atherosclerosis were significantly older than those without (30.5 years vs 25.3 years; p<.001), and a greater prevalence of dyslipidaemia, hypertension, and obesity was noted.

Conclusions

This study suggests that the prevalence of early atherosclerosis in the modern era may be lower than in previous decades. However, it is not clear how the findings of this military study extend to the general population, particularly given the recent rise in rates of diabetes and obesity.

▸ Webber BJ, Seguin PG, Burnett DG, et al. Prevalence of and risk factors for autopsy-determined atherosclerosis among US service members, 2001–2011. JAMA 2012;308:2577–83.

PCSK9 antibody decreases LDL cholesterol in statin-intolerant patients

Approximately 10–20% of patients are unable to tolerate statins or the higher doses needed to achieve low-density lipoprotein (LDL) cholesterol goals. Perprotein convertase subtilisin/kexin type 9 (PCSK9) mediates the binding and trafficking of LDL receptors, and in phase 1 studies a human monoclonal antibody to …