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July 25, 1959


Author Affiliations

300 Central Park West New York 24.

JAMA. 1959;170(13):1585-1586. doi:10.1001/jama.1959.03010130089026

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To the Editor:—  The paper by Holman, McGill, Strong, and Geer in The Journal, May 23, page 416, presents evidence for the local formation of lipids rather than filtration into the arterial bed in the pathogenesis of arteriosclerosis. The cause is ascribed to special manufacture by the local cells for lipids as well as enzyme-hormonal influence. The fatty streaking in human arteries is considered the earliest stage of the arteriosclerotic process. They, however, ignore physical causes considered by previous investigators, particularly Moschcowitz, who stressed the importance of a combination of factors of which the most important are the prolonged normal intravascular pressure plus perivascular resistance. Vascular constriction is another factor affecting local resistance. I have shown (Angiology6:556-566 [Dec.] 1955) that this results in intimal proliferation followed by fibrosis, thrombosis, infarction, and gangrene—the second, third, and fourth stages according to Holman and associates. I suggested that the early pathological

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