{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:38:24Z","timestamp":1792647504975,"version":"4.5.0"},"reference-count":71,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Activation of the renin\u2013angiotensin\u2013aldosterone\u2010system plays a major role in the pathogenesis of cardiovascular disease through, among others, endothelial dysfunction and oxidative stress. Circulating ACE2 (angiotensin\u2010converting enzyme 2) is emerging as a biomarker of cardiovascular disease risk; however, its role in younger populations is not well\u2010established. This study aimed to investigate sex differences in serum ACE2 activity and associations with endothelial dysfunction and oxidative stress\u2010related markers in young, apparently healthy men and women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In this cross\u2010sectional study, we included 1134 young (aged 20\u201330\u2009years) men (n=557) and women (n=577). Serum ACE2 activity was measured using a validated fluorometric assay. We analyzed markers of endothelial dysfunction, oxidative stress, and antioxidant capacity. We performed a 2\u2010sample\n                      <jats:italic toggle=\"no\">t<\/jats:italic>\n                      test and Mann\u2010Whitney\n                      <jats:italic toggle=\"no\">U<\/jats:italic>\n                      test. We applied multivariable\u2010adjusted Tobit regression analysis to account for left truncation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Men had higher ACE2 activity than women (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). After multiple adjustments for covariates, ACE2 activity was positively associated with von Willebrand factor (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.006), and a disintegrin\u2010like metalloproteinase with thrombospondin motif type 1 member 13 (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.019) in men. Among women, ACE2 activity was negatively associated with asymmetric dimethylarginine (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.043) and superoxide dismutase (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Serum ACE2 activity was higher in men than women and showed sex\u2010specific associations with endothelial dysfunction and oxidative stress\u2010related markers. Our results suggest an association between ACE2 shedding and pathophysiological processes associated with alterations in endothelial integrity and early endothelial dysfunction, which may be influenced by sex. This highlights the role of circulating ACE2 as a potential early biomarker of cardiovascular disease risk in young adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/\">https:\/\/clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03292094.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047345","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:26:33Z","timestamp":1792149993000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Associations of Angiotensin\u2010Converting Enzyme 2 Activity With Markers of Endothelial Dysfunction and Oxidative Stress in Young Healthy Adults: The African\u2010PREDICT Study"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7790-7669","authenticated-orcid":false,"given":"Vuledzani Felicia","family":"Maugana","sequence":"first","affiliation":[{"name":"North\u2010West University","place":["Potchefstroom, South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1863-7539","authenticated-orcid":false,"given":"Louise M.","family":"Burrell","sequence":"additional","affiliation":[{"name":"Austin Health, University of Melbourne, Heidelberg","place":["Melbourne, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0626-1899","authenticated-orcid":false,"given":"Sheila K.","family":"Patel","sequence":"additional","affiliation":[{"name":"Austin Health, University of Melbourne, 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