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Conclusions
This study for the first time reports an independent association between latitude and C-IMT, an established surrogate marker of early atherosclerosis, in a large sample of European individuals presenting with at least three VRFs. Our data thus confirm the north-to-south gradient of atherosclerotic disease already described by others in smaller samples or within single countries. The study not only shows that latitude explains a large proportion of the variation in C-IMT but also that the observed geographical gradient is independent of established and novel VRFs. This suggests that unknown mechanisms underlie this geographical gradient, candidates being heritable factors predisposing to (in the North) or protecting from (in the South) atherosclerosis.
This study also shows that a large part of the risk for the development of atherosclerosis is not explained by traditional risk factors. This finding, which is consistent with those reported by others,12–18 underscores the importance of continuing the search for novel risk factors. The most likely place to find those risk factors is in genetics and/or environmental factors with a north-to-south gradient in Europe.
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