Antioxidant state and mortality from coronary heart disease in lithuanian and swedish men: concomitant cross sectional study of men aged 50
Authors: M. Kristenson, B. Zieden, Z. Kucinskiene, A. Abaravicius, L. Razinkoviene, L. S. Elinder, B. Bergdahl, B. Elwing, H. Calkauskas, A. G Olsson
Journal: BMJ (1997)

<h3>Abstract</h3> <b>Objective:</b> To investigate possible risk factors and mechanisms behind the four times higher and diverging mortality from coronary heart disease in Lithuanian compared with Swedish middle aged men. <b>Design:</b> Concomitant cross sectional comparison of randomly selected 50 year old men without serious acute or chronic disease. Methods and equipment were identical or highly standardised between the centres. <b>Setting:</b> LinkÖping (Sweden) and Vilnius (Lithuania). <b>Subjects:</b> 101 and 109 men aged 50 in LinkÖping and Vilnius respectively. <b>Main outcome measures:</b> Anthropometric data, blood pressure, smoking, plasma lipid and lipoprotein concentrations, susceptibility of low density lipoprotein to oxidation, and plasma concentrations of fat soluble antioxidant vitamins. <b>Results:</b> Systolic blood pressure was higher (141<i>v</i> 133 mm Hg, P&lt;0.01), smoking habits were similar, and plasma total cholesterol (5.10 <i>v</i> 5.49 mmol/l, P&lt;0.01) and low density lipoprotein cholesterol (3.30 <i>v</i> 3.68 mmol/l, P&lt;0.01) lower in men from Vilnius compared with those from LinkÖping. Triglyceride, high density lipoprotein cholesterol, and Lp(a) lipoprotein concentrations did not differ between the two groups. The resistance of low density lipoprotein to oxidation was lower in the men from Vilnius; lag phase was 67.6 <i>v</i> 79.5 minutes (P&lt;0.001). Also lower in the men from Vilnius were mean plasma concentrations of lipid soluble antioxidant vitamins (ß carotene 377<i>v</i> 510 nmol/l, P&lt;0.01; lycopene 327 <i>v</i> 615 nmol/l, P&lt;0.001; and lipid adjusted tocopherol 0.25<i>v</i> 0.46 µmol/mmol, P&lt;0.001. Tocopherol concentration did not differ). Regression analysis showed that the lag phase was still significantly shorter by 10 minutes in men from Vilnius when the influence of other known factors was taken into account. <b>Conclusions:</b> The high mortality from coronary heart disease in Lithuania is not caused by traditional risk factors alone. Mechanisms related to antioxidant state may be important. <h3>Key messages</h3> Mortality from coronary heart disease in 50-54 year old men is four times higher in Lithuania than in Sweden Differences in traditional risk factors for coronary heart disease in 50 year old men in LinkÖping (Sweden) and Vilnius (Lithuania) were small–systolic blood pressure was higher in men from Vilnius, but total and low density lipoprotein cholesterol concentrations were lower and smoking habits similar The resistance of low density lipoprotein to oxidation was lower in men from Vilnius and remained after adjustment for antioxidant vitamin concentrations Plasma concentrations of the antioxidant vitamins, ß carotene, lycopene, and lipid adjusted tocopherol were lower in men from Vilnius; tocopherol did not differ Mechanisms related to antioxidant state may be important in explaining the much higher mortality from coronary heart disease in Lithuanian compared with Swedish middle aged men