Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. The Pathobiological Determinants of Atherosclerosis in Youth (PDAY) Research Group.

The raised fatty streak (fatty plaque) is the gross term for the lesion intermediate between the juvenile (flat) fatty streak and the raised lesion of atherosclerosis. We measured the percentage of intimal surface involved with flat fatty streaks, raised fatty streaks, and raised lesions in the aortas and right coronary arteries of 2876 autopsied persons aged 15 through 34 years who died of external causes. Raised fatty streaks were present in the abdominal aortas of approximately 20% of 15- to 19-year-old subjects, and this percentage increased to approximately 40% for 30- to 34-year-old subjects. Raised fatty streaks were present in the right coronary arteries of approximately 10% of 15- to 19-year-old subjects, and this percentage increased to approximately 30% for 30- to 34-year-old subjects. The percent intimal surface involved with raised fatty streaks increased with age in both arteries and was associated with high non-high density lipoprotein (HDL) and low HDL cholesterol concentrations in the abdominal aorta and right coronary artery, with hypertension in the abdominal aorta, with obesity in the right coronary artery of men, and with impaired glucose tolerance in the right coronary artery. Associations of risk factors with raised fatty streaks became evident in subjects in their late teens, whereas associations of risk factors with raised lesions became evident in subjects aged >25 years. These results are consistent with the putative transitional role of raised fatty streaks and show that coronary heart disease risk factors accelerate atherogenesis in the second decade of life. Thus, long-range prevention of atherosclerosis should begin in childhood or adolescence.

Autopsy diagnoses of malignant neoplasms: how often are clinical diagnoses incorrect?

CONTEXT: Autopsy often reveals new diagnoses of malignant neoplasms, but as technological advances to improve diagnosis during life have improved, autopsy rates have declined dramatically. OBJECTIVE: To determine if there is still a high discordance rate between clinical and autopsy diagnoses of malignant neoplasms despite increasing technological advances in diagnostic methods. DESIGN AND SETTING: A 10-year retrospective study (1986-1995) of all autopsies performed at the Medical Center of Louisiana at New Orleans. PARTICIPANTS: All patients autopsied, excluding preterm fetuses, at the Medical Center of Louisiana at New Orleans, by both Tulane and Louisiana State University Schools of Medicine in which consent was obtained or authorization given from the Orleans Parish Coroner's Office. MAIN OUTCOME MEASURES: Discordance between clinical and autopsy diagnoses of malignant neoplasms. RESULTS: A total of 1625 cases were reviewed of which 520 preterm fetuses were excluded. Of the remaining 1105 cases, 654 were male and 451 were female. The mean age was 48.3 years (range, 1-98 years). A total of 433 neoplasms were diagnosed, 250 of which were malignant. One hundred eleven malignant neoplasms in 100 patients had been either undiagnosed or misdiagnosed, and in 57 patients, the immediate cause of death could be attributed to the malignant neoplasm. The discordance between clinical and autopsy diagnoses of malignant neoplasms in this study is 44%, which is similar to previously reported studies. CONCLUSION: The discordance rate between clinical and autopsy diagnoses of malignant neoplasms is large and confirms the importance of the postmortem examination.