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[Improvement of endothelial function in patients with hypercholesterolemia and normal coronary arteries with
E Iràculis1, Cequier A, M Sabaté
1Unidad de Hemodinámica y Cardiología Intervencionista, Servicios de Cardiología, Barcelona, Spain.
Insights
Lowering lipid levels in hypercholesterolemic patients with endothelial dysfunction improved coronary vasomotion. This suggests that lipid normalization can enhance blood vessel function in individuals with high cholesterol.
Area of Science:
- Cardiology
- Vascular Biology
- Endocrinology
Context:
- Endothelial dysfunction is prevalent in patients with coronary risk factors.
- Hypercholesterolemia is associated with impaired endothelium-dependent vasomotion in epicardial arteries, even with normal coronary angiography.
- This dysfunction can precede significant coronary artery disease development.
Purpose:
- To investigate whether endothelial dysfunction in hypercholesterolemic patients with normal coronary arteries improves with lipid level reduction and normalization.
- To assess the impact of lipid-lowering therapy on endothelium-dependent coronary vasomotion.
Summary:
- The study involved 10 hypercholesterolemic patients with normal coronary arteries, assessed for endothelium-dependent vasomotion via acetylcholine infusion.
- Initial assessment revealed significant endothelial dysfunction (vasoconstriction) compared to a control group.
- After lipid-lowering therapy (diet and lovastatin) for 24 months, patients showed improved vasomotion in response to acetylcholine, correlating with reduced total cholesterol and LDL levels.
Impact:
- Lipid normalization can significantly improve endothelial function in hypercholesterolemic patients.
- This finding highlights the importance of managing lipid levels to prevent cardiovascular events.
- Targeting lipid levels may be a viable strategy to mitigate vascular dysfunction in at-risk populations.
Introduction And Aims:
In patients with coronary risk factors the presence of endothelial dysfunction in epicardial arteries has been documented. The purpose of this study was to determine whether endothelial dysfunction, documented hypercholesterolemic patients and angiographically normal coronary arteries, improves by reduction and normalization of lipid levels.
Patients And Method:
In 10 patients with hypercholesterolemia and normal coronary angiography, the endothelium-dependent coronary vasomotion was studied by intracoronary infusion of acetylcholine into the left anterior descending coronary artery. Vasomotion changes in response to acetylcholine were analyzed by quantitative angiography. Five patients without coronary risk factors and normal coronary arteries formed the control group. Patients with hypercholesterolemia were treated with lipid-lowering therapy (diet and lovastatin) and endothelial function was reevaluated after 24 +/- 4 months.
Results:
In the initial study, hypercholesterolemic patients compared with the control group showed a vasoconstrictor response to serial doses of acetylcholine(10(-6) M, 10(-5) M, 10(-4)M) indicative of endothelial dysfunction (study group: -0.3 +/- 10%, -6 +/- 4%, -18 +/- 10% vs control group: -0.6 +/- 6%, -2 +/- 6%, 3+/-6%; p < 0.01 to 10(-4) M acetylcholine dose. During follow-up hypercholesterolemic patients who a significant reduction in total cholesterol levels and LDL. Compared to first study, at follow-up, there was an improvement in the response to acetylcholine (-0.4 +/- 4%, -3 +/- 6%, -3 +/- 10%; p<0.001 vs basal values at 10(-4) M acetylcholine concentration). Reduction in total cholesterol during follow-up was related to the improvement in the vasoconstrictor response to acetylcholine (r=0.53; p< 0.05).
Conclusion:
In patients with hypercholesterolemia and angiographycally normal coronary arteries with documented endothelial dysfunction, the reduction and normalization of lipid levels during follow-up may improve endothelium-dependent coronary vasomotion.