Predictors of atherosclerosis in the Honolulu Heart Program. I. Biologic, dietary, and lifestyle characteristics

Of 8,006 men of Japanese ancestry living in Hawaii who were followed from 1966 to 1983 for incident cardiovascular disease, 1,381 died and 290 had a protocol autopsy which included determination of the extent of atherosclerosis in the coronary arteries and aorta. More than 50 biologic, lifestyle, and dietary characteristics, measured in 258 of the men who did not have existing evidence of definite coronary disease or stroke at the baseline examination, were examined for association with the measures of atherosclerosis using models which did and did not include adjustments for autopsy selection bias. Blood pressure and serum cholesterol were the strongest and most consistent predictors of atherosclerosis in both the coronary arteries and aortas. Cigarette smoking was also consistently associated with aortic atherosclerosis and inconsistently with coronary atherosclerosis. Several other variables often associated with clinical coronary artery disease in this cohort were not found to be independently associated with atherosclerosis. These included alcohol use, physical activity, serum glucose, triglyceride, and uric acid levels. None of more than 25 measures of dietary patterns and 24-hour dietary intake was associated with atherosclerosis in any statistical model. Examination of age-adjusted and age-specific levels of atherosclerosis over time from 1966 to 1983 showed a slight decrease in coronary atherosclerosis and a slight increase in aortic atherosclerosis; however, these trends were not significant. Both myocardial scars measured at autopsy and clinical evidence of myocardial infarction were significantly associated with the coronary atherosclerosis scores.