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Nonfatal acute myocardial infarction in Costa Rica: modifiable risk factors, population-attributable risks, and adherence to dietary guidelines
(Circulation Journal of the American Heart Association, Vol. 115, no. 9, 2007) Kabagambe, Edmond K.; Baylin, Ana; Campos Núñez, Hannia
Disability and mortality resulting from cardiovascular disease (CVD) are on the rise in many developing countries, partly because of the nutritional transition and westernization of lifestyles. Developing countries account for 80% of the global CVD burden. In 2002, the number of health-years of life lost to heart disease including myocardial infarction (MI) per 1000 people in developing countries was between 6 and 20 for countries such as Costa Rica, Uganda, Croatia, Nigeria, Indonesia, and India, whereas for developed countries, they were 5 for Australia, 5 for Canada, 7 for the United Kingdom, and 8 for the United States. These numbers suggest poor quality of secondary prevention and lack of primary CVD prevention in developing countries. Recent data show that primary prevention could reduce CVD deaths by 4 times the reduction achieved through secondary prevention.
Does genetic variation in the Δ6-desaturase promoter modify the association between α-linolenic acid and the prevalence of metabolic syndrome?
(The American Journal of Clinical Nutrition, Vol.89, no. 3, 2009) Truong, Hong; DiBello, Julia R.; Ruiz Narváez, Edward A.; Kraft, Peter; Campos Núñez, Hannia; Baylin, Ana
Background: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are associated with protection against components of the metabolic syndrome, but the role of α-linolenic acid (ALA), the metabolic precursor of EPA and DHA, has not been studied. The Δ6-desaturase enzyme converts ALA into EPA and DHA, and genetic variation in the Δ6-desaturase gene (FADS2) may affect this conversion.
Association between hepatic lipase -514 C/T promoter polymorphism and myocardial infarction is modified by history of hypercholesterolemia and waist circumference
(Nutrition, Metabolism and Cardiovascular Diseases, Volumen 20, no. 7, 2009) Baylin, Ana; Ruiz Narváez, Edward A.; Jensen, Majken K.; Rimm, Eric B.; Campos Núñez, Hannia
Background and aims: To examine whether the association between the 514 C/T polymorphism of the hepatic lipase gene and myocardial infarction (MI) is modified by history of hypercholesterolemia and increased waist circumference. Hepatic Lipase (HL) is a major determinant of HDL cholesterol, an established independent predictor of coronary heart disease (CHD) [1]. However, the role of HL in atherosclerosis remains uncertain. Overexpression of HL in transgenic and knockout animal models has resulted in both antiatherogenic and pro-atherogenic effects [2]. Although low HL activity in humans has been identified as a risk factor for CHD [3] the net effect of HL on CHD is hard to establish given its role in lipoprotein metabolism as both a lipolytic enzyme and as a ligand that facilitates uptake of lipoproteins [4]. Four linked polymorphisms (250 G to A, 514 C to T, 710 T to C, 763 A to G) have been identified in the promoter region of the HL gene [5]. These four poly- morphisms are in complete linkage disequilibrium and together define a common HL allele designed as 514 T allele. The T allele at position 514 of the HL gene is consistently associated with lower HL activity, higher HDL cholesterol, particularly HDL2 cholesterol, higher remnant-like particles, and triglyceride content and size of HDL and LDL particles [6]. Nevertheless, evidence of the effect of the 514 T allele on CHD is inconsistent. Some studies have shown no association [7-14], while others have shown an increased risk of CHD for carriers of the 514 T allele [15-19]. Surprisingly, the 514 T allele has not been inversely associated with CHD.
The type of oil used for cooking is associated with the risk of nonfatal acute myocardial infarction in Costa Rica
(The Journal of Nutrition, Vol. 135, no 11, 2005) Kabagambe, Edmond K.; Baylin, Ana; Ascherio, Alberto; Campos Núñez, Hannia
Palm oil and soybean oil are the 2 most widely used cooking oils in the world. Palm oil is consumed mainly in developing countries, where morbidity and mortality due to cardiovascular disease (CVD) are on the rise. Although claims about adverse or protective effects of these oils are commonly made, there are no epidemiologic studies assessing the association between these oils and cardiovascular disease endpoints. We examined whether consumption of palm oil relative to soybean oil and other unsaturated oils (predominantly sunflower) is associated with myocardial infarction (MI) in Costa Rica. The cases (n = 2111) were survivors of a first acute MI and were matched to randomly selected population controls (n = 2111). Dietary intake was assessed with a validated semiquantitative FFQ. Adipose tissue profiles of essential fatty acids were assessed to validate cooking oil intake and found to be consistent with self-reported major oils used for cooking. The data were analyzed using conditional logistic regression. Palm oil users were more likely to have an MI than users of soybean oil [odds ratio (OR) = 1.33; 95% CI: 1.08–1.63] or other cooking oils (OR = 1.23; CI: 0.99–1.52), but they did not differ from users of soybean oil with a high trans-fatty acid content (OR = 1.14; CI: 0.84–1.56). These data suggest that as currently used in Costa Rica, and most likely in many other developing countries, the replacement of palm oil with a polyunsaturated nonhydrogenated vegetable oil would reduce the risk of MI.
The relation between trans fatty acid levels and increased risk of myocardial infarction does not hold at lower levels of trans fatty acids in the costa rican food supply
(The Journal of Nutrition, Vol.136, no. 11, 2006) Colón Ramos, Uriyoán; Baylin, Ana; Campos Núñez, Hannia
Data on the effects of recent industrial modifications that reduced the trans fatty acid (TFA) content in food supplies are scarce. In this study, incident cases (n = 1797) of a first nonfatal myocardial infarction (MI) were matched with population controls (n = 1797) for age, sex, and area of residence in Costa Rica. Odds ratio (OR) and 95% CI were calculated from conditional logistic regressions before and after a reduction of TFA in Costa Rican foods. Initially, the median quintiles of total adipose tissue TFA were 1.85, 2.47, 2.99, 3.58, and 4.40 g/100 g; total TFA was positively associated with increased MI risk after adjusting for established risk factors (OR by quintiles of total TFA: 1.00, 1.37, 1.91, 1.86, 3.28; P for trend < 0.001). This association was mostly due to 18:2 trans. In contrast, after industrial modification, median quintiles of total adipose tissue TFA were 1.84, 2.26, 2.57, 2.88, and 3.42 g/100 g; the association with MI was no longer significant (OR by quintiles of total TFA: 1.00, 0.78, 1.03, 0.88, and 1.03; P for trend = 0.65). Adipose tissue 18:1 trans fatty acids were not associated with risk of MI before or after the modification. Although to date there are no TFA regulations in Costa Rica, it appears that indirect international influence has led to a TFA reduction in the food supply and, consequently, to a reduction in the risk of nonfatal MI. The public health sector of Costa Rica should regulate food labeling and content to ensure very low levels of TFA intake.
Socioeconomic development, health interventions, and mortality decline in Costa Rica
(Scandinavian Journal of Social Medicine, Supplement, No. 46, 1991) Rosero Bixby, Luis
Costa Rica, whose life expectancy was 74 years by 1985, has reached a health level comparable to a developed country. The health achievements of this country are product of political and socioeconomic circumstances as well as of right public health policies. Until about 1970 the features of Costa Rica mortality, although somewhat better than the Latin American average, evolved in a similar way to the rest of the region. In particular, the decades of 1940s and 1950s saw dramatic improvements in life expectancy, thanks mainly to the import of low-cost, high-effectiveness health technologies. In the 1970s, however, Costa Rica departed from a regional pattern of stagnation and managed to close the gap with developed countries in terms of mortality levels. A dramatic decline in the infant mortality rate from 60 to 19 per 1,000 took place in this decade. The main determinants of this breakthrough were health interventions, notably a primary health care program, even though favorable socioeconomic conditions and a reduced fertility also played a role. Ecological data and other evidence suggest that up to three fourths of the mortality decline was accounted for contemporary improvements in public health services, with about 40 percent attributable to primary health care interventions. Furthermore, by targeting interventions on the less privileged population, these interventions had the merit of reducing geographic and socioeconomic differentials in child mortality.
Tabaquismo en la mujer costarricense : 1984-85
(Editorial de la Universidad de Costa Rica, 1987) Rosero Bixby, Luis; Oberle, Mark W
Se analizan los resultados de una encuesta con representatividad nacional de 870 mujeres costarricenses con edades entre los 25 a 59 años y entrevistadas entre los años de 1984-1985. Se ve en el fumado uno de los principales factores de riesgo para las enfermedades cardiovasculares y para varios tipos de cáncer. En la mujer el tabaquismo tiene, además, otras implicaciones. En combinación con los anticonceptivos orlaes multiplica varias veces el riesgo de cardiopatías y enfermedades cerebrovasculaes y durante el embarazo el fumado puede afectar seriamente la formación del feto. En términos generales, la sociedad tiene que pagar un alto precio por el hábito del fumado, tanto en daños a la salud como en los gasto de atención médica, incapacidades y seguros. Para el caso costarricense de las entrevistadas, el 14 por ciento declararon ser fumadoras al momento de la encuesta y el 21 por ciento que alguna vez lo habían practicado. La prevalencia del fumado resultó mayor entre las mujeres con más educación, pertenecientes a los estratos socioeconómicos más altos y entre las residentes en las zonas urbanas. La mayoría de las fumadoras comenzaron a fumar antes de los 25 años de edad. Entre las más jóvens comenzaron con el hábito del fumado entre los 15 y los 24 años y estas representan más del doble que en la población más vieja, Se concluye que las estrategias para prevenir el fumado en las mujeres costarricenses, deben centrar su atención en las jóvenes adolescentes, especialmente en los grupos socioeconómicamente mejor acomodados. LOB/LOB
Política nacional de salud 2002-2006
(Ministerio de Salud, 2003) Costa Rica. Ministerio de Salud
La realidad social del país ha evidenciado la necesidad de contar con instrumentos de planificación que den una orientación clara del rumbo que en materia sanitaria debe seguir el país y determinar el uso más adecuado de los recursos. En este marco y apoyada en la legislación, así como en la experiencia que las instituciones del sector han ido desarrollando se hace imperioso contar con los lineamientos que canalicen el accionar en materia de salud para mantener y mejorar los índices de salud de la población. En este sentido, la Política Nacional de Salud desarrolla los principios y las acciones estratégicas principales para ser implementadas por el sector durante la presente administración. Vale anotar, que la Política Nacional de Salud se fundamenta en el conocimiento de la realidad del país evidenciada en el reciente Análisis del Sector, el cual mostró de manera fehaciente la situación sanitaria de nuestro país y permitió identificar las acciones prioritarias que debemos desarrollar en este campo para lograr los cambios que en materia sanitaria deben ser impulsados. El proceso de elaboración de la Política Nacional de Salud contó con la amplia participación de representantes de las instituciones del sector así como de otros sectores, cuyo aporte fue muy significativo para definir las acciones a seguir. En este proceso se integraron funcionarios del Ministerio de Salud, la Caja Costarricense de Seguro Social, del Instituto Costarricense de Acueductos y Alcantarillado, del Instituto Nacional de Seguros, del Instituto sobre Alcoholismo y Farmacodependencia, del Instituto Costarricense de Investigaciones y Educación en Nutrición y Salud, de las universidades, municipalidades, Consejo Nacional de Rehabilitación y otros actores sociales de importancia para el sector. Instrumento que ponemos al servicio del país y que permitirá orientar y fortalecer el esfuerzo encaminado a la protección, mantenimiento y mejoramiento de la salud del país. La evaluación, el monitoreo y los procesos de rendición de cuentas son los instrumentos que permitirán en el futuro medir el impacto de las políticas que hoy presentamos a la sociedad.
Frecuencia del alelo causante de la enfermedad de Charcot-Marie-Tooth (tipo axonal con herencia autosómica recesiva) en Palmares, Costa Rica
(Revista de Biología Tropical/International Journal of Tropical Biology and Conservation;, Vol 57 (Suplemento 1), 2009) Rojas Araya, Melissa; Bonilla Carrión, Róger Enrique; Campos, Sergio; Centeno, Carolina; Del Valle, Christian; Pacheco, Juan Pablo; Saborío, Alina; Vega, Jovel; Fernández, Hubert; Leal Esquivel, Alejandro
La enfermedad de Charcot-Marie-Tooth constituye el grupo de neuropatías periféricas hereditarias más común a nivel mundial. Una familia con 18 afectados del cantón de Palmares (Alajuela, Costa Rica) con una neuropatía de tipo axonal y herencia autosómica recesiva, permitió localizar el gen responsable en la región 19q13.33. Posteriormente se identificó la mutación causante en el gen MED25. El presente estudio determinó la frecuencia del alelo mutante, así como la distribución geográfica de este alelo. En una muestra al azar de 103 individuos se encontraron seis individuos heterocigotas para la mutación, distribuidos por todo el cantón. No se encontró ninguna persona en estado homocigota para este alelo. No hallamos alguna característica clínica que difiera significativamente entre los individuos homocigotos silvestres y los heterocigotos para la mutación. El 5.83% de la población es heterocigota y la frecuencia del alelo Ala335Val es de 0.029, seis veces mayor que en una muestra de toda la población costarricense. Por esta razón se recomienda un análisis molecular de portadores con el fin de alertar sobre la posibilidad de aparición de más casos en el cantón. The Charcot-Marie-Tooth disease constitutes is among the most frequent hereditary peripheral neuropathies world-wide. We identified a family from Palmares (Alajuela, Costa Rica) with 18 affected members. Their neuropathy is axonal, with an autosomal recessive pattern of inheritance; the responsible gene is at the 19q13.33 chromosomal region. Later the mutation was identified in gene MED25. We studied the frequency and geographic distribution of the mutant allele. In a random sample of 103 individuals, six were heterozygote and were widely distributed in Palmares. There was no person in homozigote state for the mutant allele. Clinical characteristics do not differ significantly between individuals that are homozygous for the wildtype allele and individuals heterozygous for the mutation. A 5.83 % of the population is heterozygote and the frequency of the Ala335Val allele is 0.029, six times higher than in a sample of the Costa Rican population. We recommend a molecular analysis of carriers to detect additional cases in the region.
Dietary patterns and risk of nonfatal acute myocardial infarction in Costa Rican adults
(European Journal of Clinical Nutrition, Vol. 60, no. 6, 2006) Martínez Ortiz, J. A.; Fung, T. T.; Baylin, Ana; Hu, F. B.; Campos, Hannia
Cardiovascular disease (CVD) has become an important public health problem in transition countries in Latin America (Medina and Kaempffer, 2000; Cubillos-Garzón et al., 2004; Ventura and Mehra, 2004; World HealthOrganization, 2004). Because changes in dietary intake are, in part, likely responsible for the increase in CVD during the past 20–30 years (Popkin, 2001), it is essential to identify foods that could play a role on CVD in developing countries. Food pattern analysis has become a valuable tool to examine the effects of diet on chronic disease (Jacques and Tucker, 2001; Hu, 2002). A major advantage of this procedure is that it takes into account multiple dietary factors, including nutrient and non-nutrient components, which could have complex effects on disease risk (Hu, 2002). In the context of Western countries, two main patterns that relate to CVD have been identified. In one study in men (Hu, 2002), a Western dietary pattern consisting primarily of red and processed meat, refined grains, sweets and desserts, French fries, and high-fat dairy products was associated with increased risk of coronary heart disease. In Denmark, a prudent dietary pattern consisting of whole meal bread, fruit, and vegetables was protective against all cause and cardiovascular mortality (Osler et al ., 2001). In the same study, no association with mortality was found for a Western pattern characterized by high intake of meat products, potatoes, white bread, butter, and lard. Consistently, a Mediterranean style diet which includes olive oil, fiber, fruits, vegetables, fish and alcohol, and reduced in meat and meat products was also protective against myocardial infarction (MI) (Martinez-Gonzalez et al ., 2002). The purpose of our study is to identify dietary patterns that are associated with risk of incident MI in Costa Rica, a Latin American country in transition (Reddy, 2004).
Abdominal obesity and hyperglycemia mask the effect of a common APOC3 haplotype on the risk of myocardial infarction
(Am J Clin Nutr., no. 87, 2008) Ruiz Narváez, Edward A.; Sacks, Frank M; Campos, Hannia
The plasma concentration of apolipoprotein (apo) C-III is a strong predictor of the risk of coronary heart disease (CHD) (1, 2). Apo C-III impairs the clearance of apo B lipoproteins from plasma, which results in an increase in plasma triacylglycerol concentrations (3–7) and directly activates atherosclerotic and inflammatory pathways in vascular cells (8, 9). Therefore, genetic variation affecting the expression of the APOC3 gene may alter apo C-III metabolism and influence CHD. Minor alleles of the 3238C - G (SstI site), -482C-T, and -455T-C polymorphisms are associated with higher plasma triacylglycerol (10–13) and apo C-III (14) concentrations and with an increased risk of CHD (13, 15–17).
Effect of apolipoprotein E genotype and saturated fat intake on plasma lipids and myocardial infarction in the Central Valley of Costa Rica
(Human Biology, Vol. 79, no. 6, 2007) Yang, Yadong; Ruiz Narváez, Edward A.; Kraft, Peter; Campos, Hannia
Apolipoprotein E (apoE) is a ligand for the low-density lipoprotein (LDL) receptor and the LDL receptor-related protein (LRP) (Mahley and Rall 2000). Through these receptors apoE mediates the uptake of chylomicron remnants into the liver and the uptake of circulating very low density lipoprotein (VLDL) and intermediate-density lipoprotein (IDL) particles into peripheral tissues and cells (Mahley and Rall 2000).
Triggers of nonfatal myocardial infarction in Costa Rica : heavy physical exertion, sexual activity, and infection
(Annals of epidemiology, Vol. 17, no. 2, 2007) Baylin, Ana; Hernández Díaz, Sonia; Siles, Xinia; Kabagambe, Edmond K.; Campos, Hannia
The incidence of coronary heart disease is increasing in developing countries undergoing socioeconomic transition(1). Lifestyles in many of these countries are dramatically different from those in Europe and the United States. For ex-ample, vigorous physical activity is more likely to be related to work than to recreational activities(2). The pattern of acute infections also is distinct, with a greater incidence than in developed countries. In addition, because transition countries are characterized by the presence of both infectious and chronic disease (3), the study of gastroenteritis episodes as a trigger of myocardial infarction (MI) is of particular interest in these countries. Cardiovascular disease (CVD) as a major health problem was established only recently in transition societies, and very few studies examined factors affecting CVD in the context of these different lifestyles(4).
Adipose tissue arachidonic acid and the metabolic syndrome in Costa Rican adults
(Clinical Nutrition, no. 26, 2007) Williams, Eric S.; Baylin, Ana; Campos, Hannia
Arachidonic acid, an n-6 polyunsaturated fatty acid (PUFA), is a major component of mammalian cell membranes and may account for up to 25% of all phospholipid fatty acids. Although it is consumed in the diet in meats, eggs, and some fish, it is also synthesized in the liver from linoleic acid, the most abundant dietary PUFA, and transported to other cell types via serum albumin or lipoproteins. A major function of arachidonic acid is to serve as a precursor to the eicosanoid family of autocrine and paracrine hormones that modulates immune and inflammatory responses in the body. Additionally, there is evidence that arachidonic acid may act as a transcriptional regulator by modulating signal transduction at the cell surface, by altering membrane fluidity, or cell surface interactions by acylating membrane proteins.
Transient exposure to coffee as a trigger of a first nonfatal myocardial infarction
(Epidemiology, Vol. 17, No.5, 2006) Baylin, Ana; Hernández Díaz, Sonia; Kabagambe, Edmond K.; Siles, Xinia; Campos, Hannia
Coffee is one of the most popular beverages worldwide, with an average consumption of 6.7 million tons per year. Prepared from the seed of the coffee plant Coffea arabica originated in Ethiopia and domesticated in Yemen, this beverage has been part of the diet for the past 5 centuries. Coffee contains many biologically active compounds, including caffeine, diterpenes, and polyphenols, with numerous metabolic properties and diverse health effects. Because of the potential adverse effects of coffee on blood cholesterol, homocysteine, and hypertension, the effects of coffee intake on heart disease have been extensively studied for decades. Findings are still controversial, with most case–control studies showing increased heart disease risk for heavy drinkers and cohort studies showing both negative and positive results. Some authors have suggested that this discrepancy is the result of a more acute effect of coffee on the risk of myocardial infarction that could be better assessed using a case–control design. More recent studies have observed a J-shaped association between coffee drinking and heart disease, which suggests that people with light or occasional intake could be at higher myocardial infarction risk because coffee may act as a trigger of myocardial infarction. The transient effects of coffee intake on increased blood pressure and sympathetic tone support this hypothesis. It has also been suggested that the disruption of a vulnerable atherosclerotic plaque in response to hemodynamic stress could trigger a myocardial infarction.
Adipose tissue biomakers of fatty acid intake
(American Journal of Clinical Nutrition, No.76, 2002) Baylin, Ana; Kabagambe, Edmond K.; Siles, Xinia; Campos, Hannia
The use of biomarkers to assess dietary intake has increased dramatically in the past few years (1-7). Biomarkers may provide a more accurate and objective measure of long-term intake than dietary questionnaires provide because biomarkers do not rely on memory, self-reported information, or interviewer bias. However, nutrient concentrations in tissue or blood do not always reflect dietary intake because they can be affected by genetic factors, smoking, obesity, physical activity, and metabolism.
Decreased consumption of dried mature beans is positively associated with urbanization and nonfatal acute myocardial infarction
(The Journal of Nutrition, vol 35, no. 7, 2005) Kabagambe, Edmond K.; Baylin, Ana; Ruiz Narváez, Edward A.; Siles, Xinia; Campos, Hannia
Beans, Phaseolus vulgaris, are legumes that are thought to have originated from southern Mexico and Central America over 7000 y ago (1); they still form an important part of the staple diet in those regions. For many centuries, beans have remained part of the human diet in several countries on all continents. Black beans or black Spanish beans are the commonest variety in Latin America; they are usually consumed as dried mature beans together with rice. The combination of rice and dried mature black beans (later referred to as beans) supplies various nutrients including essential amino acids, folate, soluble fiber, copper, magnesium, iron, potassium, calcium, zinc, and _-linolenic acid (2–10). Although there are several varieties of beans that occur in different sizes, shapes, and colors, their nutrient composition is quite similar to that of black beans (Table 1). Legumes including beans may protect against cardiovascular disease (CVD)3 through various mechanisms (2,5,10,11). However, epidemiologic data on the association between individual legumes such as beans and peas and CVD are lacking. Beans form the core of the Latin American staple diet and contribute significantly to energy and micronutrient intakes (5–7,12). Despite the recommendation to increase the intake of beans by health organizations (8), their consumption, as well as that of other legumes, has decreased with urbanization (13). This is probably because of the increased availability and advertising of relatively cheap simple carbohydrate diets such as pasta and white bread (7,13). As expected, these trends are likely to be responsible for the increased obesity and the slow emergence of cardiovascular and other chronic diseases in many Latin American countries, including Costa Rica, where myocardial infarction (MI) accounts for 47.2% of CVD (14,15). Some of the few studies that have investigated the nutrients in beans [e.g., fiber (16 –18), folate (19), magnesium (20,21), and copper (22)], suggest inverse associations with CVD. Unlike soybeans and peanuts, the role of other legumes (e.g., beans) in CVD has not been reported. We therefore investigated, in a large incident case-control study in Costa Rica, whether eating beans is associated with risk of MI and explored potential mechanisms for such an association.
Some dietary and adipose tissue carotenoids are associated with the risk of nonfatal acute myocardial infarction in Costa Rica
(The Journal of Nutrition, Volumen 135, no. 7, 2005) Kabagambe, Edmond Kato; Furtado, Jeremy; Baylin, Ana; Campos, Hannia
Antioxidants, particularly carotenoids and tocopherols, may protect against cardiovascular disease. The objective of this study was to determine whether dietary and adipose tissue carotenoids and tocopherols are associated with the risk of myocardial infarction (MI). Cases (n 1456) of a first acute MI were identified and matched by age, sex, and residence to randomly selected population controls (n 1456) living in Costa Rica. Carotenoids and tocopherols were measured in adipose tissue using HPLC. Dietary intake was assessed using a validated FFQ. Anthropometrical and lifestyle data were collected using an interviewer-administered questionnaire. Subjects were distributed into quintiles of intake or adipose tissue concentration of carotenoids or tocopherols. The lowest quintile was used as the referent in conditional logistic regression analyses. Adipose tissue-carotene showed a significant inverse relation with MI risk; the odds ratio (OR) comparing the highest to the lowest quintile was 0.70 (95% CI: 0.51– 0.96, P for trend 0.02). Intake of fruits and vegetables that are rich in-carotene was also inversely associated with the risk of MI (OR 0.74; CI: 0.54 –1.01, P for trend 0.09). In contrast, lutein zeaxanthin in adipose tissue (OR 1.46; CI: 1.05–2.05, P for trend 0.02) and diet (OR 1.18; CI: 0.88 –1.57, P for trend 0.02) was positively associated with MI risk. MI risk was not associated with any of the other carotenoids or tocopherols in the diet or adipose tissue. Thus, the inverse association between -carotene and MI risk suggests that -carotene protects against MI or it is a marker of some protective factor in foods containing -carotene. The mechanism underlying the positive association between lutein zeaxanthin and the risk of MI warrants investigation.
APOC3/A5 haplotypes, lipid levels, and risk of myocardial infarction in the Central Valley of Costa Rica
(Journal of Lipid Research, vol. 46, no. 12, 2005) Ruiz Narváez, Edward A.; Yang, Yadong; Nakanishi, Yukiko; Kirchdorfer, Jill; Campos, Hannia
Apolipoprotein C-III (apoC-III) and A-V (apoA-V) regulate triglyceride metabolism in opposite ways (1–3). In mice, the overexpression of the human APOC3 transgene (1) leads to severe hypertriglyceridemia, whereas knockout mice lacking the endogenous Apoc3 gene have hypotriglyceriemia (2). In contrast, overexpression of the human APOA5 transgene and the lack of the endogenous Apoa5 gene show opposite triglyceride effects (3). Several studies indicate that naturally occurring sequence variation in the APOC3 and APOA5 genes affects plasma triglyceride concentrations in humans (4–7). People with the G allele of the 3238C>G polymorphism (SstI site) in the 3 untranslated region (3 UTR) of APOC3 tend to have higher plasma triglyceride concentrations (4, 5), as do individuals with two minor alleles, 482C>T and 455T>C (8–10), found in the insulin response element (IRE) of the APOC3 promoter. Several minor alleles of APOA5, the 1131T>C (upstream of the proximal promoter) (3, 6, 7), c. 3A>G (in a putative Kozak sequence) (11), c.56C>G (amino acid change p.Ser19Trp in the signal peptide) (7, 11), IVS3 476G>A (3, 11), c.553G>T (amino acid change p.Gly185Cys in exon 3) (12), and c.1259T>C (located in the 3 UTR) (3, 11), are also associated with increased plasma triglyceride concentrations.
Alcohol intake, drinking patterns and risk of nonfatal acute myocardial infarction in Costa Rica
(The American Journal of Clinical Nutrition, vol. 82, no. 6, 2005) Kabagambe, Edmond K.; Baylin, Ana; Rimm, Eric B.; Campos, Hannia
Moderate consumption of alcohol in developed countries has been associated with a reduced risk of myocardial infarction (MI) (1–3). This evident protection is thought to be due to improved plasma lipid profiles, particularly an increase in HDL cholesterol (4–6), increased adiponectin (7), reduced plasma fibrinogen (8), viscosity (9), platelet activity (10, 11), C-reactive protein (8, 12), and improved insulin sensitivity (13). However, the protective effect of alcohol is not uniform across sex and populations or socioeconomic classes (14, 15), which raises doubts as to whether alcohol per se is truly protective or instead is a marker for another protective factor associated with alcohol consumption (4). Others have suggested that certain types of alcohol, eg, wine, may be more protective than others (16 –18). Growing evidence (2, 6, 14) suggests that the amount and pattern of intake, rather than the type of alcohol (19, 20), are more important in explaining the effects of alcohol in populations. Other studies suggest that sex (14) and genetic diversity of alcohol users (6, 21) may also play an important role in explaining the observed protection and differences across studies. For instance, in a recent prospective study, alcohol was inversely related to MI in white Americans but was hazardous for hypertension and MI in African Americans (14, 22). These disparities could be due to differences in alcohol intake patterns or the prevalence of functional genetic polymorphisms in genes encoding alcoholmetabolizing enzymes that have been reported across races (23–26). Polymorphisms in the alcohol dehydrogenase gene have been associated with changes in bothHDLcholesterol and risk of MI in moderate drinkers (6). Apart from one multicountry study (3) in which consumption of alcohol was marginally associated with a reduced risk of MI, to date, no large case-control studies have investigated the association between alcohol intake, patterns, and risk of MI in developing countries where diet and lifestyles differ from those in Western cultures. We conducted a large (n = 4548), matched, incident casecontrol study of residents of the Central Valley of Costa Rica, a country with low wine intake, to determine whether alcohol users, compared with self-reported lifelong abstainers, are less likely to have an MI. We also determined whether the pattern of alcohol drinking is associated with the risk of MI or intermediate phenotypes such as plasma lipid concentrations.

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