Abstract
Cardiovascular disease (CVD) is a major cause premature death. Considerable efforts have been made to identify CVD risk factors, including dietary micronutrients. However there are no data on the relationship between micronutrients and CVD in Saudi Arabia despite the high prevalence of cardiovascular disease in the Middle East. Dietary intake was assessed by questionnaire in Saudis with established CVD (n=130) and age-matched controls (n=130). Demographic factors, lipid profile, serum trace elements, inflammatory markers and markers of antioxidant status were measured in each subject. There was a high prevalence of coronary risk factors among cases and controls, however, type 2 diabetes mellitus (p<0. 0001), a positive smoking habit (p<0. 0001) and hypertension (p<0. 05) were more prevalent among CVD patients. They also had a higher intake of energy, total fat, cholesterol, selenium, zinc, copper and vitamin A (p<0. 05 for all). Serum selenium, urinary copper (p<0. 001) and urinary zinc (p<0. 05) concentrations were lower among CVD patients. Controls (n=303) were stratified by age, race, and socioeconomic (SE) class to investigate the association between nutritional factors and the risk and prevalence of coronary disease. Dietary energy and absolute carbohydrate intake fell with age and increased with SE class (p<0. 05). The youngest group had the highest dietary intake of energy, fat, cholesterol (p<0. 05), the highest % energy provided by SFA (p<0. 001), and the lowest % energy as PUFA (p<0. 05) compared to the other age groups. The intake of fiber also rose with age, and was significantly higher in the older group (p<0. 05). Higher % energy as fat, dietary PUFA and PUFA/SFA ratio among subjects of low SE class than those of middle SE class (p<0. 05). Mean cholesterol and SFA intake was higher among subjects of Arabian descent than those of Mediterranean background (p<0. 05). Subjects of Mediterranean background had higher PUFA/SFA ratio than Asians and those of Arabian descent (p<0. 05). Among the controls without CVD (n=140), stratified by age; serum caeruloplasmin was positively associated with age and Framingham Risk Score whilst soluble intercellular adhesion molecule-1 (sICAM-1) was negatively associated with HDL-C among diabetic subjects. New Zealand White rabbits were fed with copper, zinc, both, or neither, and allocated to a cholesterol or normal chow diet for 12 weeks (n=8 per group). The cholesterol-fed animals were matched for integrated serum cholesterol levels. Dietary supplementation with either zinc, copper, or both was associated with reduced atherosclerotic lesion formation (p<0. 05). Plasma concentrations of lipid peroxides were significantly higher in the cholesterol-fed rabbits compared with the chow fed animals (P<0. 001) and these were reduced significantly by dietary copper or zinc supplementation (p<0. 001).