Abstract
Mediterranean diet has been suggested to explain why coronary heart disease mortality is lower in southern than northern Europe. Dietary habits can be revealed by isotope ratio mass spectrometry (IRMS) measurement of carbon (δ13C) and nitrogen (δ15N) in biological tissues. To study if diet is associated with human plaque stability, atherosclerotic plaques from carotid endarterectomy on 56 patients (21 Portuguese and 35 Swedish) were analysed by IRMS and histology. Plaque components affecting rupture risk were measured. Swedish plaques had more apoptosis, lipids and larger cores, as well as fewer proliferating cells and SMC than the Portuguese, conferring the Swedish a more rupture-prone phenotype. Portuguese plaques contained higher δ13C and δ15N than the Swedish, indicating that Portuguese plaques were more often derived from marine food. Plaque δ13C correlated with SMC and proliferating cells, and inversely with lipids, core size, apoptosis. Plaque δ15N correlated with SMC and inversely with lipids, core size and apoptosis. This is the first observational study showing that diet is reflected in plaque components associated with its vulnerability. The Portuguese plaques composition is consistent with an increased marine food intake and those plaques are more stable than those from Swedish patients. Marine-derived food is associated with plaque stability.
Highlights
Age Gender Symptoms Time between symptoms and operation Degree of stenosis (%) Type 2 diabetes Hypertension Smoking Statin use Fasting lipoproteins: Cholesterol Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Triglycerides
To understand the role of diet in Coronary heart disease (CHD) mortality, we investigated the dietary origin of the nitrogen and carbon molecules present in atherosclerotic plaques obtained from Portuguese and Swedish carotid surgery patients
We used mass spectrometry to analyse carbon and nitrogen isotope ratios in human atherosclerotic plaques and expressed the isotopic fractionation in terms of δ 13C and δ 15N. The distribution of these isotopes in living tissues reflects their dietary origin with high levels of both reflecting marine dietary sources, fish (Fig. 1a)[15,16,17,18,19,20,21]
Summary
Age (years) Gender (males) Symptoms Time between symptoms and operation (days) Degree of stenosis (%) Type 2 diabetes Hypertension Smoking (currently) Statin use Fasting lipoproteins (mmol/L): Cholesterol Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Triglycerides. Nitrogen (δ 15N) can be used to differentiate between different types of terrestrial and marine-derived food (Fig. 1a). To understand the role of diet in CHD mortality, we investigated the dietary origin of the nitrogen and carbon molecules present in atherosclerotic plaques obtained from Portuguese and Swedish carotid surgery patients. We analysed how the dietary origin of the plaque nitrogen and carbon molecules related to structural components associated with plaque stability
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