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But whether hypertension causes arteriosclerosis, or vice versa, no one knows. A similar change in major arteries is often seen in the aged: the muscular wall hardens so much that the vessels are called "pipestem arteries." In an otherwise healthy individual this condition may go undetected and do no apparent harm.
Atherosclerosis is the bugbear. It appears to attack the coronary arteries with especial frequency. And strangely, it is a disease of successful civilization and high living. It is far commoner in the U.S., Britain, Sweden and Denmark than among the poor peasants of Sardinia and southern Italy, the paddyfield workers of China and Japan, or Bantu tribesmen. It is commoner among men than among pre-menopausal women; after the menopause, women gradually become as susceptible as men, though it takes them until age 80 to catch up. Racial origin, body build, smoking habits and the amount of physical activity also have been implicated. And, of course, the Gog and Magog of modern medicine: stress and strain.
The Question of Fat. The University of Minnesota's Physiologist Ancel Keys recently set up all these theories in a neat line and then charged down it, tilting at them one by one. Items:
¶"The popular picture of the coronary victim as a burly businessman, fat and soft from overeating and lack of exercise, who smokes and drinks too much because [of his stressful climb to the top] is a caricature." The type exists, but often escapes coronary disease while men of other types fall victim to it.
¶Families with a "bad heredity" for coronary disease attract attention. Dr. Keys depicted a "family" showing 31 descendants of one great-grandfather: twelve apparently died of coronary disease. But the "family" was fictitious, constructed from U.S. averages. The most that Dr. Keys will concede is a possible "familial tendency."
¶Race may mean little, because U.S. Negroes living well in Chicago have about the same rates as whites, though Africans whose ancestors escaped slavery in the U.S. are spared the disease. U.S. citizens of Italian descent approximate U.S. average rates, and not those of their second cousins in the old country.
¶Despite their poverty, many peasant peoples smoke as many cigarettes as they can get, and often down to the last tarry fraction of an inch, without developing heart disease.
¶Obesity and overweight are too often confused: a man may be overweight with muscle without being obese, or may have flabby fat on a small frame without being overweight. Without condoning "gross obesity," Dr. Keys could assign it "no more than some aggravating or accelerating influence."