Fetal Atherosclerosis


From a recent Italian study we learn of coronary artery disease in fetuses and newborns that is truly amazing.

I remember when research teams announced the presence of coronary artery disease with plaque deposition and fatty streaks in routine autopsies done on young solders killed in action. These 18-19 year old kids, lean as a rail with flat bottom cholesterols were found to have surprising degrees of atherosclerosis. We young doctors were all surprised.

Now similar pathology is found in the offspring of smoking mothers. 88-94% of the fetuses and babies of smoking mothers were found to have these lesions, which were almost negligible when the mothers were non-smokers.

This is almost beyond belief to those of us indoctrinated these past 40 years with the cholesterol hypothesis. Information in the same ballpark is the fact that 50% of acute first time myocardial infarction deaths are associated with completely normal cholesterol levels.

If one is seeking additional soil to bury even deeper the concept of cholesterol etiology of atherosclerosis, they need look no further than these studies. Professor Jose Milei of Barcelona evaluated the autopsy data from 22 fetal deaths and 36 victims of sudden infant death syndrome (SIDS) for possible correlation with maternal cigarette smoking. 48% of the mothers involved were smokers.

The major epicardial coronary arteries were serially cut for histological examination. After preparation and microscopic examination, multi-focal coronary lesions were detected in 83% of fetuses and 94% of infants of smoking mothers. Only in five cases (2/10 fetuses and 3/20 infants) were arterial lesions observed in infants with non-smoking mothers.

This role of maternal cigarette smoking in the onset of early coronary atherosclerotic lesions in fetuses and infants might have been suspected before but no one has so convincingly reported on this problem. This reminds me of the words of Linus Pauling that "We are all thrombogenic by nature."

He postulated that some 45 million years ago as our ancestors were beginning their descent from the trees to the savannah floor we traded our vitamin C synthesizing ability for our lipoprotein (A) substance. This aggressive little cholesterol carrying protein molecule is covered with receptors for lysine, proline and glycine, the fiber-like components of collagen.

Any tiny break in our collagen matrix will bring lipoprotein (A) running to seal the injured tissue and promptly stop the bleeding. Since these tiny almost-children have few other possible inflammatory agents to contend with, their mother's smoke conceivably is sufficiently toxic to the delicate new endothelium to call forth our inherent thrombogenic response.

Now there is no doubt that atherosclerosis begins very early in our tenuous lives and young female minds must be made to understand their obligation to smoking cessation as well as all the other long list of things they must do to help their baby be healthy.

Upon conception, each of us is dealt a different hand of cards. Future mothers must understand their responsibility in helping their children get a good start and be all they can be. The results of this research study should be part of every school's health curriculum.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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