COULD ANTIOXIDANTS PLAY A ROLE IN HIGH-RATES OF CORONARY HEART-DISEASE IN THE CZECH-REPUBLIC

Objectives: To compare plasma levels of antioxidant vitamins in the Cz ech population with those in a western European population, and to inv estigate whether plasma levels of antioxidant vitamins in Czech popula tion are related to risk of MI. Design: The study has two parts: a cro ss-sectional survey and a population based case-control study. Setting : Adult population in two districts of the Czech Republic, and London based civil servants group as the comparison. Subjects: A random sampl e of men and women aged 25-64 y resident in two districts were selecte d for the cross- sectional survey. Subjects in the age group 40-49 y w ere compared to a sample of British civil servants of the same age enr olled in the Whitehall II Study. Men in the Czech sample served as con trols to 52 male cases of first non-fatal myocardial infarction (MI) w hich occurred in the same population. Plasma samples were obtained fro m venepuncture during an interview in hospital in the population sampl e and immediately after hospitalization in the MI cases. Main outcome measures: Plasma levels of beta-carotene and alpha-tocopherol, and the event of MI. Identical protocol and one laboratory was used for all a nalyses. Results: The mean plasma levels of beta-carotene and alpha-to copherol in healthy Czech men and women were substantially lower than in a subsample of British civil servants examined in the same laborato ry. Smoking was strongly related to beta- carotene in both populations but differences between Czechs and Brits were present in both smokers and non-smokers. In the case-control study among Czech men, low level s of the vitamins were strongly related to an increases risk of MI. Ag e-adjusted odds ratios for concentrations below the median were 3.33 ( 95% confidence interval 1.43-8.33) for beta-carotene and 1.89 (0.94-3. 45) for alpha-tocopherol; further adjustment for a range of variables reduced these estimates only slightly. Conclusions: Plasma concentrati ons of antioxidants in the Czech population appeared to be very low, a nd men with low levels of these substances are at increased risk of MI . This indicates that sub-optimal intake of antioxidants or related di etary factors may have played a role in the high rates of coronary hea rt disease in this population.