A qualitative assessment of the degree of atherosclerotic involvement of six major arteries in 310 autopsies of Ghanaian adults revealed that atherosclerosis is less severe in Ghanaians compared to Caucasians. Atherosclerosis increases with age, more so in hypertensives, but severe lesions are not common in cerebral vessels in spite of the high mortality from haemorrhagic stroke in the adult Ghanaian. Severe atherosclerosis is, therefore, not important in the causation of cerebral haemorrhage. The small number of cerebral infarcts (six) is in keeping with the absence of severe atherosclerotic lesions in both extra cranial and intracranial large arteries. Absence of severe coronary lesions also parallels the low incidence of myocardial infarction and ischaemic heart disease is Ghanaians. Diabetes mellitus in combination with hypertension results in more severe atherosclerosis of the aorta and coronary arteries but the effect of diabetes mellitus alone requires further study.