Background . Atherosclerosis (ATS) is a common age-related disease of large arteries. The prevalence of older subjects with vascular successful aging (VaSA), defined as the absence of clinical symptoms and instrumental signs of ATS, is low in Western countries. The possible contribution of genetics to the VaSA phenomenon is not known. THEROSCLEROSIS (ATS), a progressive age-related disease of the large arteries characterized by the accumulation of lipids and fibrous elements, is the primary cause of coronary heart disease (CHD) and stroke, and represents the underlying cause of about 50% of all deaths in Western countries (1). The prevalence of ATS increases significantly with age, and only a few older individuals have no evidence of ATS when evaluated at one vascular site, for instance the carotid arteries (2). The percentage of older subjects without ATS in several vascular districts is not known, but it is conceivably much smaller. This highly selected group might represent a useful model to investigate the factors that protect against the development of ATS and allow the individual to achieve successful aging at the vascular level (3). In a previous study, we found that very old ATS-free subjects have higher plasma levels of vitamin E and lower levels of low-density lipoprotein (LDL) oxidation compared with age-matched controls with documented ATS (4). However, epidemiological studies have shown that not only environmental but also genetic factors contribute to the development of the atherosclerotic plaques. Indeed, it has been suggested that the fraction of disease explained by genetics within a population is high and often exceeds 50% (1).
MethodsATS is considered a polygenic disease, and, in the past few years, a large number of genetic risk factors have been reported, including the polymorphisms in angiotensin converting enzyme (ACE) (5), methylenetetrahydrofolate reductase (MTHFR) (6), apolipoprotein E (apo E) (7), and paraoxonase (PON) genes (8). ACE converts angiotensin I into angiotensin II, a potent vasopressor peptide, and also inactivates bradykinin (9). The ACE gene has a common insertion/deletion (I/D) polymorphism in intron 16 (5), and the D allele has been associated with CHD and left ventricular hypertrophy in adult populations (9). MTHFR is a key enzyme in the metabolism of homocysteine, and elevated plasma levels of this amino acid have been associated with the development of ATS (10). A relatively common point mutation at nucleotide 677 of the MTHFR gene is responsible for a thermolabile variant of the enzyme that has been associated with increased homocysteine levels (10). Apo E is a polymorphic plasma protein that modulates the metabolism of triglyceride-rich atherogenic lipoproteins (11). A growing body of evidence indicates that apo E polymorphism plays a significant role in the susceptibility to develop ATS; indeed, individuals bearing the 4 allele have higher total cholesterol levels and an increased risk of developing CHD (7). PON is a high-density lipoprotein (HDL)-associated enzy...