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Relationship between vascular dysfunction in peripheral arteries and ischemic episodes during daily life in patients
Eva Søndergaard1, Jacob E Møller, Kenneth Egstrup
1Department of Medicine, Svendborg Hospital, Svendborg, Denmark. evas@dadlnet.dk
Insights
Patients with ischemic heart disease and high cholesterol show a link between daily ischemia and endothelial dysfunction. This suggests endothelium-targeted therapies may be beneficial for preventing cardiovascular events.
Area of Science:
- Cardiology
- Vascular Biology
- Clinical Medicine
Background:
- Endothelial dysfunction is common in ischemic heart disease and hypercholesterolemia.
- Transient myocardial ischemia can occur during daily life in these patients.
- Brachial vasoreactivity assesses endothelial function.
Purpose of the Study:
- To investigate the correlation between daily ischemic episodes and endothelial dysfunction.
- To assess endothelial function using brachial artery vasoreactivity.
Main Methods:
- 131 patients with ischemic heart disease and hypercholesterolemia were included.
- 48-hour Holter monitoring recorded ischemic episodes (ST-segment depression).
- Brachial artery ultrasound measured flow-mediated and nitroglycerin-mediated vasoreactivity.
Main Results:
- 181 ischemic episodes were recorded in 31 patients.
- Flow-mediated and nitroglycerin-mediated vasodilatation were negatively correlated with ischemic episodes (r = -0.249, P =.006 and r = -0.302, P =.02).
- Ischemic episodes predicted impaired flow-mediated vasodilatation (beta = -3.31, P <.01).
Conclusions:
- A significant relationship exists between daily ischemic episodes and vascular dysfunction.
- Endothelial dysfunction is linked to transient ischemia in patients with ischemic heart disease and hypercholesterolemia.
- Aggressive preventive therapy targeting the endothelium may be warranted.
Background:
It is well established that endothelial dysfunction is present in patients with ischemic heart disease and hypercholesterolemia. Some of these patients will have signs of transient myocardial ischemia during Holter monitoring. We sought to describe the correlation between daily life ischemia and signs of endothelial dysfunction as assessed by means of brachial vasoreactivity.
Methods:
We included in the study 131 patients with documented ischemic heart disease and a serum cholesterol level of > or =5 mmol/L before the institution of lipid-lowering treatment and dietary intervention.
Results:
Satisfactory 48-hour Holter recordings and ultrasound scans of the brachial artery were obtained in 119 patients. During 5712 hours of ambulatory monitoring, 181 episodes of transient ST-segment depression with a mean duration of 52 +/- 66 minutes were recorded in 31 patients. The mean percentage dilatation of the brachial artery after occlusion was 4.38% +/- 5.66%; after nitroglycerin administration, it was 13.86% +/- 7.06%. By means of Spearman correlation analysis, the number of ischemic episodes and degree of flow-mediated vasodilatation and nitroglycerin-mediated vasodilatation were significantly negatively correlated (r = -0.249, P =.006 and r = -0.302, P =.02, respectively). In a linear regression model, the presence of ischemic episodes was a significant predictor of impaired flow-mediated vasodilatation (beta = -3.31, P <.01), even after the adjustment for vessel size and classic cardiovascular risk factors.
Conclusions:
These results indicate a significant relationship between ischemic episodes and vascular dysfunction in patients with ischemic heart disease and hypercholesterolemia and may justify an aggressive preventive therapy targeted directly at the endothelium.
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