Metabolic and endocrine aspects of coronary disease

The early history, the nature and the incidence of coronary atherosclerosis and ischaemic heart disease have been reviewed. Evidence has been presented to suggest that there are aetiological factors which favour the development of ischaemic heart disease without influencing the incidence of coronary atherosclerosis. The close relationship of cholesterol metabolism to coronary atherosclerosis and to ischaemic heart disease has been emphasised. The circulating lipids and lipoproteins have been studied in health in relation to age and sex. They were abnormal in the majority of patients with ischaemic heart disease, particularly in those under the age of 50. Analysis of the circulating lipids and lipoprotein could aid the solution of an equivocal diagnosis in young subjects suspected of having ischaemic heart disease. The effects of endogenous hormones and the action of administered hormones on the circulating lipids and lipoproteins have been described in detail. Hormones can also influence the fluid state of the blood and the tonicity and metabolism of arteries. It has been postulated that the homeostasis of cholesterol metabolism, of the fluid state of the blood and of arterial metabolism could be disturbed by alteration of the physiological endocrine balance. The thesis has been proposed that an endocrine imbalance could contribute to the development of coronary atherosclerosis and of ischaemic heart disease. The relationship of this thesis to existing theories of the aetiology of ischaemic heart disease has been considered in detail. Finally, some therapeutic implications of these metabolic and endocrine aspects of coronary disease have been considered