Abstract
In Azores, the standardized mortality rate for coronary artery disease (CAD) is nearly the double when compared to mainland Portugal. The aim of this study was to compare the prevalence of conventional CAD risk factors, as well as the plasma aminothiol profile (and its major determinants), between two groups of healthy subjects from Ponta Delgada (in Azores) and Lisbon (in mainland) cities, searching for precocious biomarker(s) of the disease. The study groups consisted of 101 healthy volunteers from Ponta Delgada (PDL) and 121 from Lisbon, aged 20–69 years. No differences in the prevalence of classical CAD risk factors were found between the study groups, except in physical inactivity and related central obesity, which were both higher in PDL men than in those from Lisbon. Hypercysteinemia, which seems to result from sulfur-rich amino acid diets and/or vitamin B12 malabsorption, revealed to be significantly more prevalent in PDL vs. Lisbon subjects (18% vs. 4%, P=0.001), namely, in male gender. Moreover, plasma Cys levels predicted waist circumference (β coefficient = 0.102, P=0.032) and concomitant central obesity and were also associated with insulin resistance. Nevertheless, hyperhomocysteinemia prevalence was similar in both groups, despite the fact that PDL subjects exhibited a higher rate of vitamin B12 deficiency compared to those from Lisbon (19% vs. 6%, P=0.003). Owing to the nature of this study design, a cause-effect relationship between high plasma Cys levels and central obesity or CAD risk could not be derived, but results strongly suggest that hypercysteinemia is a potential risk factor for metabolic disorders, i.e., obesity and insulin resistance, and CAD in Azores, a hypothesis that asks for confirmation through further large prospective studies.
Highlights
Atherosclerotic cardiovascular diseases (CVD) are the main cause of death and disability in Portugal, where the Azores islands still have the highest standardized mortality rate for coronary artery disease (CAD), nearly twice the observed one in mainland Portugal [1].Atherosclerosis is a chronic, inflammatory, multifactorial condition which can develop as a silent and progressive disease, whose underlying mechanisms are complex and can vary from one population to another [2]
Ponta Delgada (PDL) subjects had lower diastolic blood pressure (BP) and higher levels of creatinine, glucose, and homeostasis model assessment of insulin resistance (HOMA-IR) score compared to their counterparts from Lisbon, the latter parameter did not reach statistical significance when analyzed by gender. ere were no differences in serum mean levels of urea, uric acid, and insulin, as well as in lipid profile between the study groups, except in HDL-c concentrations
The prevalence of either standard risk factors for atherosclerosis or hyperhomocysteinemia is similar in both study groups
Summary
Atherosclerotic cardiovascular diseases (CVD) are the main cause of death and disability in Portugal, where the Azores islands still have the highest standardized mortality rate for coronary artery disease (CAD), nearly twice the observed one in mainland Portugal [1].Atherosclerosis is a chronic, inflammatory, multifactorial condition which can develop as a silent and progressive disease, whose underlying mechanisms are complex and can vary from one population to another [2]. Oxidative stress plays a key role in atherogenesis since the beginning and all along the progression of the pathology. It is defined as an imbalance between the production of reactive oxygen species (ROS) and their elimination by the antioxidant defense systems, with a prevailing pro-oxidant status that results in macromolecular damage and disruption of cellular redox signaling. Oxidative stress is the unifying mechanism for many CVD risk factors [3], such as obesity and diabetes mellitus, and it activates proinflammatory signaling pathways. Since classical risk factors fail to account for part of the CVD cases and oxidative stress can have a causal role in these diseases [4], it is important to identify early, noninvasive oxidative stress biomarkers in healthy populations in order to define precociously subjects at high-risk for CVD
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