Meraji S, Abuja P M, Hayn M, Kostner G M, Morris R, Oraii S, Tatzber F, Wonisch W, Zechner R, Gey K F
Shahid Rajaii Hospital, Cardiovascular Research Centre, Tehran University of Medical Sciences, Tehran, Iran.
Atherosclerosis. 2000 Jun;150(2):403-12. doi: 10.1016/s0021-9150(99)00394-9.
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.
总体而言，心血管疾病（CVD）似乎是包括伊朗在内的东地中海地区（EMR）的主要死因。这可能归因于高甘油三酯（TG）、高总胆固醇（TC）和低水平高密度脂蛋白胆固醇（HDL-C）等经典风险因素。在伊朗，抗氧化剂作为预防早期冠心病（CHD）的潜在保护风险因素的影响尚不清楚。因此，在一项病例对照研究中，对心绞痛与血浆抗氧化剂及脂质过氧化指标之间的关系进行了调查。在本研究中，通过改良的WHO罗斯胸痛问卷确定并经跑步机运动试验期间的心电图证实的82例既往未诊断的心绞痛（AP）患者，与从4000多名40 - 60岁男性公务员同一人群中选取的146名对照进行了比较。与年龄匹配的对照组相比，AP患者自述的体力活动明显较少，血清TG水平较高[均值（标准误）2.32（0.18）对1.61（0.07）mmol/L]，但HDL-C水平较低[1.01（0.04）对1.18（0.03）mmol/L]。两组之间总血清胆固醇、低密度脂蛋白胆固醇（LDL-C）和脂蛋白（a）[Lp（a）]水平无显著差异，而AP患者的LDL-C/HDL-C比值显著高于对照组[4.51（0.23）对3.54（0.11）]。血浆α-生育酚、维生素C、α-和β-胡萝卜素水平无显著差异。然而，视黄醇[1.90（0.06）对2.09（0.05）]和β-隐黄质[0.398（0.04）对0.467（0.03）]在AP患者中显著较低。此外，心绞痛患者的脂质过氧化指数高于对照组（如丙二醛，MDA；0.376（0.010）对0.337（0.009）μmol/L）。在多因素logistic回归分析中，视黄醇的比值比（OR）为0.644[95%置信区间（CI；0.425 - 0.978）]，β-隐黄质的OR为0.675（CI；0.487 - 0.940），氧化指标MDA的OR为1.612（95%CI；1.119 - 2.322）以及LDL-C/HDL-C比值的OR为2.006（95%CI；1.416 - 2.849）在这组伊朗人群中显示出与AP最显著的独立关联。总之，脂质过氧化状态以及特定抗氧化剂的状况可能与心血管疾病的经典风险因素的影响并行，共同决定伊朗AP的发生。
