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A study among more than 3,000 men has demonstrated that aggressive behavior plays a major pathogenetic role in coronary heart disease—a role that is independent of traditional risk factors such as elevations in serum cholesterol and blood pressure. Unless behavior pattern is taken into account in evaluating coronary risk, efforts to reduce the premature coronary death toll may fall short of their goal.

Undertaken to clarify the precursors of coronary disease-a task admirably carried out through its definition of “coronary risk profiles”-Framingham has also demonstrated the potential of the long-term, prospective study in unravelling the causes of other chronic illnesses. Among those on which its findings have shed considerable light are stroke, diabetes, arthritis, cholecystitis, and emphysema.

Twenty-six moderately obese men (mean weight 88·6 kg.) were given a weight-reducing diet as outpatients. Weight loss occurred at varying rates for an average period of 9·7 months, remaining steady thereafter at 76·5 kg. for a mean period of 18·5 months. All but three men had coronary heart-disease. On entry twelve men had type-IIa hyperlipidaemia, ten had type IIb, and four had "normal" lipid levels. On entry mean serum-cholesterol and triglyceride levels were 307 and 181 mg. per 100 ml., respectively. In the steady-weight state serum-cholesterol and triglyceride levels fell to 237 and 113 mg. per 100 ml., respectively, and five men now had type IIa, two type IIb, and two type IV (all mild), and seventeen had normal lipids. The change in body-weight and calculated low-density-lipoprotein cholesterol was the same in types IIa and IIb. There was a correlation between fall in serum-cholesterol and weight loss. Weight loss (or calorie reduction) made a larger contribution to lowering serum-cholesterol than reduction of saturated fat and cholesterol. In eleven men further reduction of dietary saturated fat and addition of polyunsaturated oils after weight reduction did not appear to lower cholesterol or triglycerides further. An additional fourteen obese hypercholesterolaemic men who adhered faithfully to the same diet but did not lose weight achieved only a 4·5% reduction of serum-cholesterol. These data suggest that both body-weight and the composition of the diet are important determinants of serum-cholesterol levels and that the response to both factors varies from person to person. Weight gain after maturity which affects half the Australian population makes an important contribution to type II and to type IV hyperlipidaemia and should therefore be regarded as an important coronary risk factor.

THE diagonal ear-lobe crease described below appears more commonly in patients with coronary heart disease and should be regarded as a coronary risk factor. Although other risk factors may be prese...

The concept of coronary risk and the practical application of this concept among those men at excess risk is important for a number of reasons.

The relative amount of glycoproteins present in electrophoretically separated serum protein fractions was investigated in 4 groups of persons: (1) in normal persons, i.e. control group, (2) in myocardial infarction survivors, (3) in patients with stenocardia, (4) in clinically healthy men with elevated β-/α-lipoprotein index, i.e. coronary risk group. Glycoproteins present in albumin and α 1 -globulin fractions were higher both in myocardial infarction and in patients with stenocardia as well as in coronary risk group in comparison with the control group. Glycoproteins present in α 2 - and β-globulin fractions were lower in each of the studied groups compared with the control group. All described differences were statistically significant.

The physician is frequently asked these simple and seemingly innocuous questions: "Does emotional stress bring on heart attacks?" "Is coffee drinking bad for you?" "Is exercise good for you?" "Which coronary risk factor is the most important?" Such cocktail-hour questions from patients, colleagues and friends are among the more difficult in medicine to answer with assurance. Approaches to the scientific study of questions about coronary risk are illustrated in two articles contained in this issue, one by Friedman and his co-authors on the total leukocyte count, and one by Jenkins et al. about answers to a behavioral questionnaire, both in . . .

Excerpt To the editor: In a 6-year study of a stratified random sample of the population aged 30 to 59 years of Framingham, Massachusetts, factors related to the development of coronary heart disea...