Review

An Integrated Proposal to Explain the Epidemic of Cardiovascular Disease in a Developing Country
From Socioeconomic Factors to Free Radicals
Patricio López-Jaramillo^a,b,c, Juan P. Casas^a, Leonelo Bautista^b,c, Norma C. Serrano^d, Carlos A. Morillo<sup>b,c

a</sup>Instituto Colombiano de Investigaciones Biomédicas,
^bFundación Cardiovascular del Oriente Colombiano (FCV),
^cUniversidad Industrial de Santander, and
^dUniversidad Autónoma de Bucaramanga, Colombia

Address of Corresponding Author

Cardiology 2001;96:1-6 (DOI: 10.1159/000047379)

  Key Words

• Cardiovascular disease
• Dimethylarginine dimethylaminohydrolase
• Endothelial dysfunction
• Infection
• Nutrition

  Abstract

An increase of coronary artery disease has been observed in developing countries during the last years. Various factors may explain this accelerated increase. We propose that inappropriate diet and inadequate sanitary infrastructure may act as triggers to create an imbalance between nitric oxide (NO) and superoxide (O^-₂). An increase in the concentrations of oxidizedLDL produces both decreased NO and increased O^-₂ endothelial synthesis, by accumulation of asymmetrical N^G-N^G-dimethyl-L-arginine, the endogenous inhibitor of NO, and by activation of NAD(P)H oxidase. On the other hand, high rates of chronic infection-inflammation, due to inappropriate sanitary environment stimulate higher circulating levels of proinflammatory cytokines. These cytokines also contribute to reduced NO and increased O^-₂ endothelial production through the same mechanisms of oxidized LDL. The net result of this imbalance is an increased generation of peroxynitrate that injures the endothelium in a proatherogenic, prothrombotic and vasoconstrictive manner.

Copyright © 2001 S. Karger AG, Basel

  Author Contacts

Carlos A. Morillo, MD
Department of Cardiology and Cardiovascular Sciences, FCV
Instituto del Corazón, Calle 155ª No 23-58, 3rd Floor
Urbanización El Bosque Sector E-1. AA, 1143 Bucaramanga (Colombia)
Tel. +577 6399603, Fax +577 6392744, E-Mail cmorillo@fcv.org

  Article Information

Received: Received: June 24, 2001
Accepted: July 9, 2001
Number of Print Pages : 6
Number of Figures : 3, Number of Tables : 1, Number of References : 41