Relationship between classic risk factors, plasma antioxidants and indicators of oxidant stress in angina pectoris (AP) in Tehran
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Published on: February 7, 2018
1Shahid Rajaii Hospital, Cardiovascular Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Insights
This study found that increased lipid peroxidation and lower levels of certain antioxidants like retinol and beta-cryptoxanthin are associated with angina pectoris in Iranian men. These factors, along with traditional cardiovascular risks, may contribute to coronary heart disease.
Area of Science:
- Cardiology
- Nutritional Science
- Biochemistry
Background:
- Cardiovascular disease (CVD) is a leading cause of death in the Eastern Mediterranean Region, with traditional risk factors including high triglycerides, total cholesterol, and low HDL-C.
- The role of antioxidants and lipid peroxidation in the development of early coronary heart disease (CHD) in Iran remains unclear.
Purpose of the Study:
- To investigate the relationship between angina pectoris (AP) and plasma antioxidant levels and indicators of lipid peroxidation in Iranian men.
- To identify potential novel risk factors for AP beyond classical CVD risk factors.
Main Methods:
- A case-control study involving 82 previously undiagnosed angina pectoris cases and 146 age-matched controls from a population of male civil servants aged 40-60 years.
- Data collection included a modified WHO Rose chest pain questionnaire, electrocardiography during treadmill testing, and measurement of plasma lipid profiles, antioxidants (retinol, beta-cryptoxanthin, etc.), and lipid peroxidation markers (malondialdehyde).
Main Results:
- Angina cases showed significantly higher serum triglyceride levels, lower HDL-C, and a higher LDL-C/HDL-C ratio compared to controls.
- Plasma levels of retinol and beta-cryptoxanthin were significantly lower in subjects with AP.
- Indicators of lipid peroxidation, such as malondialdehyde (MDA), were significantly higher in angina cases.
- Multiple logistic regression identified retinol, beta-cryptoxanthin, MDA, and the LDL-C/HDL-C ratio as significant independent predictors of AP.
Conclusions:
- The state of lipid peroxidation and the levels of specific antioxidants (retinol, beta-cryptoxanthin) are associated with angina pectoris in Iranian men.
- These factors may act as co-determinants of AP, alongside established cardiovascular risk factors.
- The findings suggest potential targets for intervention and prevention strategies for coronary heart disease in the region.
Abstract:
Cardiovascular disease (CVD) in general seems to be the leading cause of death in the Eastern Mediterranean Region (EMR) including Iran. This may be due to classic risk factors such as high triglyceride (TG), high total cholesterol (TC), and low levels of high density lipoprotein cholesterol (HDL-C). The impact of antioxidants as potentially protective risk factors against early coronary heart disease (CHD) is unknown in Iran. Therefore, relationships between angina and plasma antioxidants and indicators of lipid peroxidation were investigated in a case-control study. In this study, 82 cases of previously undiagnosed angina pectoris (AP), identified by a modified WHO Rose chest pain questionnaire and verified by electrocardiography during treadmill exercise testing, were compared with 146 controls selected from the same population of over 4000 male civil servants aged 40-60 years. Subjects with AP declared significantly less physical activity and had higher serum TG [means (S.E.M.) 2.32 (0.18) versus 1.61 (0.07) mmol/l] but lower HDL-C [1.01 (0.04) versus 1.18 (0.03) mmol/l] than age-matched controls. Levels of total serum cholesterol, low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] were not significantly different between the two groups, while the ratio of LDL-C/HDL-C was significantly higher [4.51 (0.23) versus 3.54 (0. 11)] for subjects with AP than for the controls. There was no significant difference in plasma levels of alpha-tocopherol, vitamin C, alpha- and beta-carotene. However, retinol [1.90 (0.06) versus 2. 09 (0.05)] and beta-cryptoxanthin [0.398 (0.04) versus 0.467 (0.03)] were significantly lower in AP. Furthermore, angina cases exhibited a higher index of lipid peroxidation than controls (e.g. malondialdehyde, MDA; 0.376 (0.010) versus 0.337 (0.009) micromol/l). On multiple logistic regression analysis, retinol with odds ratio (OR) of 0.644 [95% confidence interval (CI; 0.425-0.978)], beta-cryptoxanthin, with an OR of 0.675 (CI; 0.487-0.940), oxidation indices, MDA with OR of 1.612 (95% CI; 1.119-2.322) and LDL-C/HDL-C ratio with OR of 2.006 (95% CI; 1.416-2.849) showed the most significant independent associations with AP in this group of Iranians. In conclusion, the state of lipid peroxidation as well as the status of special antioxidants may be co-determinants of AP in Iran, in parallel with the influence of classical risk factors for cardiovascular disease.
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