Reactive Oxygen Species-Mediated Cardiovascular Disease In Diabetes: A Sex-Stratified Case-Control Study In Punjab, Pakistan

Abstract

This study investigates sex-based differences in reactive oxygen species (ROS)-mediated cardiovascular disease (CVD) development among diabetic individuals residing in central Punjab, Pakistan. A case-control study was carried out on 200 participants, comprising 100 males and 100 females, each further divided into diabetic and non-diabetic (control) groups. All participants underwent thorough clinical evaluation and detailed medical history recording. Fasting serum samples were analyzed for lipid profile parameters including total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Additionally, oxidative stress markers — superoxide dismutase (SOD), reduced glutathione (GSH), malondialdehyde (MDA), catalase (CAT), and nitric oxide (NO) — were quantified. Diabetic females exhibited significantly elevated TC, TG, and LDL levels (p=0.001) alongside reduced HDL (p=0.045) compared to non-diabetic female controls. Likewise, diabetic males demonstrated increased TC and TG (p=0.001) with decreased HDL (p=0.05) relative to their non-diabetic counterparts. Inter-group comparison revealed that diabetic females had significantly higher cholesterol, LDL (p=0.045), and TG (p=0.001) levels than diabetic males. Regarding oxidative stress, diabetic females showed markedly reduced SOD, GSH, CAT, and NO levels (p<0.001), along with elevated MDA (p=0.001), compared to non-diabetic females. Furthermore, when compared to diabetic males, diabetic females displayed significantly lower SOD (p=0.001) and GSH (p=0.05) with correspondingly higher MDA levels (p=0.05). These findings suggest that women with diabetes are at a greater risk of developing CVD than their male counterparts. This sex-based disparity in oxidative stress and lipid dysregulation may offer valuable insights for the development of more targeted and sex-specific therapeutic strategies.