Abstract

Atherosclerosis occurs commonly in both coronary and peripheral arteries in populations with a Western life-style. It is a necessary, but perhaps not sufficient, factor in the development of the arterial occlusions associated with infarctions and thromboses. As Sinclair has pointed out, atherosclerosis and myocardial infarction appear to be dissociated in populations consuming coconut oil, which is rich in lauric (13:0) and myristic (14:0) fatty acids. In such populations atherosclerosis is common, whereas myocardial infarction is relatively rare. The list of factors associated with coronary and peripheral artery disease is well known. In epidemiological terms, a Western diet, male sex, smoking, age, and diabetes are all associated with increased risk. Pathophysiologic factors associated with these diseases include elevated cholesterol and triglyceride levels, increased platelet aggregation, blood viscosity and smooth muscle proliferation, and elevated blood pressure. Risk of developing fatal arrhythmias may be a major factor in converting arterial disease into sudden death. Any explanation of atherosclerosis and its coronary and peripheral vascular consequences must therefore be related to the above known life-style and pathophysiologic factors. Over 30 years ago Sinclair argued that an understanding of essential fatty acid (EFA) metabolism might be important in explaining vascular disease. Since then, much evidence has accumulated to support and modify his hypothesis and this evidence will be reviewed here.