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Hemodynamic Factors in Atherosclerosis

William Dock, MD
JAMA. 1965;193(11):979-980. doi:10.1001/jama.1965.03090110117047.
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To the Editor:—  In the July 5 issue (193, adv p 39, 1965) you call attention to the exhibit which confirmed impressive evidence, published over the last quarter century, that atheromas occur earliest and become most severe at sites where the intima normally is thick (coronary arteries), or is thickened by disease (syphilitic aortitis, dissecting aneurysms, or experimental injury). The exhibitors related intimal thickening to rapid flow, with reduced lateral pressure, and conclude "fluid mechanics are the primary factor in etiology of atheroscleosis."The hydrodynamics of flow are obviously the same in the rich and poor, the Korean soldier and the American. Yet, as Osler pointed out 70 years ago, coronary disease is very rare in the poor as compared with the prosperous. Korean soldiers have lipid-free thickenings of the coronaries (as have infants, rabbits, and elephants) while 50% of Americans, aged 22 years, have gross atheromas, and 10% have


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