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Autopsy study of 124 Ethiopian patients for atherosclerotic lesions and myocardial infarction revealed aortic lesions in 58 (47%), coronary lesions in 26 (21%) and myocardial infarction in 8 (6.5%) cases. Fatty streaks in the coronary arteries were detected after the age of 19 years. Thereafter the frequency increased gradually with age reaching a peak of 33.3% by the age group of 50-59 years. Fibrous plaque appeared at the age of 40 years and progressed with age reaching a maximum of 44.4% by the age of 60-69 years. Myocardial infarction was the cause of sudden death in two cases. Six of the patients with myocardial infarction had moderate to severe lesions. Calcification with narrowing of the left anterior descending coronary artery was found in a 60-year-old female. The significance of the increasing incidence of CHD in black Africans and particularly in Ethiopians is discussed.