Abstract
Sex differences have been previously highlighted in the cardioprotective effects of the Mediterranean diet (MedDiet). The objective of this study was to investigate whether sex differences also exist with regard to LDL particle size distribution and oxidation. Participants were 37 men and 32 premenopausal women (24–53 years) with slightly elevated LDL-C concentrations (3.4–4.9 mmol/L) or total cholesterol/HDL-C ≥5.0. Variables were measured before and after a four-week isoenergetic MedDiet. Sex differences were found in response to the MedDiet for the proportion of medium LDL (255–260 Å) (p for sex-by-time interaction = 0.01) and small, dense LDL (sdLDL; <255 Å) (trend; p for sex-by-time interaction = 0.06), men experiencing an increase in the proportion of medium LDL with a concomitant reduction in the proportion of sdLDL, while an opposite trend was observed in women. A sex difference was also noted for estimated cholesterol concentrations among sdLDL (p for sex-by-time interaction = 0.03), with only men experiencing a reduction in response to the MedDiet. The MedDiet marginally reduced oxidized LDL (oxLDL) concentrations (p = 0.07), with no sex difference. Results suggest that short-termconsumption of the MedDiet leads to a favorable redistribution of LDL subclasses from smaller to larger LDL only in men. These results highlight the importance of considering sex issues in cardiovascular benefits of the MedDiet.
Highlights
Lowering LDL-C concentration is the primary target of therapy for the prevention of cardiovascular disease (CVD) [1,2,3]
Even if there were no difference between men and women for LDL-C concentrations before the Mediterranean diet (MedDiet), some sex differences were observed in LDL physico-chemical properties (Table 1)
No difference was found between men and women for all of the other variables related to LDL particle size features (p > 0.08)
Summary
Lowering LDL-C concentration is the primary target of therapy for the prevention of cardiovascular disease (CVD) [1,2,3]. In addition to LDL-C concentrations, it has been shown that a more detailed analysis of LDL physico-chemical properties (e.g., size and oxidation) provides further insight into individual cardiovascular risk [4,5,6]. LDL particles (sdLDL) are at increased risk of coronary heart disease compared to those with larger, buoyant LDL particles [7,8,9]. Compared with large LDL, sdLDL possess a lower affinity for the LDL receptor and a longer half-life in plasma [10], bind more tightly to arterial proteoglycans [11], penetrate the arterial subendothelial space more [12] and are more susceptible to oxidation [13]. Oxidized LDL (oxLDL) concentrations have been identified as an important marker of atherosclerotic lesions [5,6]
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