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European Heart Journal Advance Access originally published online on October 17, 2007
European Heart Journal 2007 28(23):2841-2849; doi:10.1093/eurheartj/ehm446
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007.For permissions please email: journals.permissions@oxfordjournals.org

South-to-North gradient in lipid peroxidation in men with stable coronary artery disease in Europe

María Grau1,2, Mònica Guxens1,2, Isaac Subirana1, Montserrat Fitó1, María-Isabel Covas1, Benedicte Jacquemin3, Jordi Sunyer3, Timo Lanki4, Sally Picciotto5, Tom Bellander6, Klea Katsouyanni7, Alexandra Schneider8, Annette Peters8, Jaume Marrugat on behalf of the AIRGENE Study Group1,2,*

1 Lipids and Cardiovascular Epidemiology Unit, Municipal Institute Medical Research (IMIM) Barcelona, Carrer Dr Aiguader, 88, E-08003 Barcelona, Spain
2 PhD Programme in Public Health and Methodology of Biomedical Research, Universitat Autònoma de Barcelona, Spain
3 Centre for Research in Environmental Epidemiology (CREAL) Barcelona, Spain
4 Unit of Environmental Epidemiology, Department of Environmental Health, National Public Health Institute, Kuopio, Finland
5 Local Health Authority RM E, Department of Epidemiology ASL, Rome, Italy
6 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
7 Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
8 GSF-National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany

Received 3 May 2007; revised 6 September 2007; accepted ; online publish-ahead-of-print 17 October 2007.

* Corresponding author. Tel: +34 933160710; fax: +34 933160796. E-mail address: jmarrugat{at}imim.es

Aims: A South-to-North gradient across Europe exists for the incidence of coronary artery disease (CAD) rates. Low-density lipoprotein (LDL) oxidation is a hallmark of atherosclerosis and CAD development. The aim of our study was to determine whether differences exist in the degree of LDL oxidation in stable CAD patients from different regions of Europe.

Methods and results: A cross-sectional multicentre study included 790 stable CAD male subjects aged 35–79 years (61.4 ± 9.5) from six European countries in three regions by latitude: Northern (Finland and Sweden), Central (Germany), and Southern (Greece, Spain, and Italy). Plasma oxidized LDL (oxLDL) levels were determined. Alcohol intake and lipid profile were significantly associated with oxLDL. The Italian participants had the highest oxLDL levels. A sensitivity analysis showed the models yielded higher adjusted oxLDL values in Northern (63.8 U/L) than in Central (57.6 U/L) and Southern populations (56.5 U/L), P < 0.001, after excluding Italian subjects. The probability of Southern Europe scoring the lowest oxLDL levels was >71% in all fitted models.

Conclusion: Our findings suggest a gradient in LDL oxidation from Southern to Northern Europe that consistently holds for all levels of LDL, except for Italy; this country displays the highest levels in Europe, for unknown reasons.

Key Words: Atherosclerosis • Lipid peroxidation • Oxidative stress • Epidemiology • Coronary artery disease


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