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There were 1,166 deaths from all causes in the Borough for 1954 so we may
note that 441 deaths from atheroma is more than one-third of the total. So
atheroma is an important disease. We should be trying our best to ascertain
the cause and learning how to prevent it. Unfortunately the outlook at the
moment is bleak. The real cause is unknown; but certain facts about the
condition are known. The disease might be called athero-sclero-thrombosis.
Parts of the wall of an artery become diseased and weak; the substance is
replaced by fibrous tissue. The wall of the artery becomes thickened and
distorted; then the lumen becomes narrowed and finally the roughened internal
coat can start a blood clot, the consequences of which can be serious or even
disastrous by cutting off the blood supply to the part served by the artery.
When this is the heart muscle itself the condition is called angina, and when
the blood clots it is called coronary thrombosis.
It is difficult to detect atheroma during life. It can begin in childhood
and go on throughout the whole of life. When the arteries of the heart are
examined at post-mortem in people who have died of coronary thrombosis,
a high proportion show evidence of severe atheroma.
There circulates in the blood stream a substance called cholesterol which
is thought to be an important cause of atheroma. The patches of atheroma
contain cholesterol; the blood cholesterol level in humans is higher than in
other animals which do not suffer from atheroma as a rule. Animals can be
given atheroma by feeding with large amounts of cholesterol. High cholesterol
content of the blood in man causes severe atheroma. Patients who have suffered
from coronary atheroma have on the average higher cholesterol in their blood
than other people of the same age and sex. The blood cholesterol level tends
to rise gradually from childhood until the 50's in people who live on diets rich
in fat, but does not continue to rise so late in life in those accustomed to have
low fat intake. Coronary atheroma is more prevalent in men than in women.
The severity of the degree of atheroma in women is about 20 years behind men
of corresponding age. The highest amounts of cholesterol are found in the blood
of men round about age 40, and especially in those men who suffer from coronary
thrombosis. Coronary thrombosis increases in women after the menopause
and the incidence becomes equal in men and women at about age 70. It thus
appears that women are protected in some way during the child-bearing years.
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