Cardiac hypertrophy is frequently found at autopsy in persons with disease of the coronary arteries. An extracoronary mechanism is nearly always responsible for this hypertrophy. In this report, however, we wish to emphasize that gross cardiac hypertrophy is often absent in disease of the coronary arteries even though other marked pathologic changes of the vessels and heart are present. The term disease of the coronary vessels as employed here needs clarification. It is, of course, well known that the coronary vessels often appear arteriosclerotic at necropsy. But this condition, in a strict sense, is not a disease; it probably represents a metabolic process assailing many structures, among them blood vessels. The arteriosclerotic alteration of such vessels is, in a certain respect, the testimony and stigma of advancing years. Markedly sclerotic vessels are sometimes seen in comparatively young persons; generally, however, arteriosclerosis occurs in the later decades of life and attacks