Secular Trends in Coronary Atherosclerosis

To the Editor: Enriquez-Sarano et al. (Aug. 1 issue)¹ observed no change in angiographic measures of coronary atherosclerosis in 601 patients with isolated nonischemic valvular regurgitation, both mitral (n = 385) and aortic (n = 216), between 1980 and 1989. They acknowledge the limitations of the study, particularly with respect to the generalization of results to the general population.The point of interest and perhaps concern is that both patients with aortic regurgitation and those with mitral regurgitation were included in the study. The hemodynamics of coronary blood flow in these two conditions are clearly different. In aortic regurgitation large-caliber . . .