UNDER THE KNIFE
William Newman is one of three pathologists on Berenson's team who analyzed the tissues collected from the autopsies. He was also directly involved in harvesting the specimens. Whenever a young person in Bogalusa died, Newman and a colleague would drive the 66 miles up from Louisiana State University School of Medicine in New Orleans to Bogalusa to perform the autopsy for the coroner.
What Newman and his colleagues saw when they opened the hearts of the young people shocked them: fatty streaks lining the coronary arteries that supply the heart muscle with blood, as well as the aorta, the major artery leaving the left ventricle of the heart, ultimately supplying blood to the rest of the body. Virtually all the individuals autopsied had these fatty streaks, and the extent of streaking increased with age.
As Newman explains, a fatty streak is an early form of atherosclerosis, a disease that restricts blood flow in blood vessels. He says you can identify these streaks when you cut open a vessel because they “look a bit yellow.” They also retain a lipophilic (“fat-loving”) dye, which makes them more apparent and easily quantified.
To quantify the extent of atherosclerosis, each pathologist would look at every autopsy specimen and assign the stained fatty streaks a score, and the scores were then averaged together. The study was blind, so the pathologists didn't know the source of the tissues beforehand. Once they had these measurements, statisticians correlated these anatomical measurements with known risk factors for heart disease—things like high blood pressure, smoking, and high cholesterol—the young people had when they were alive. The result? “We found that those individuals who had higher levels of known risk factors on the average had more fatty streaks in their coronary arteries and the aortas than individuals who had lower levels,” says Newman.
9
In other words, though many of them were not even old enough to vote, these young people already had telltale signs of heart disease. Some even had evidence of more severe atherosclerosis in the form of fibrous plaques that had begun to obstruct blood flow. Had these young people lived, those with the higher levels of atherosclerosis would have been at risk for a heart attack or other complications of heart disease (INFOGRAPHIC 27.4).
