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Relation between high-density lipoprotein cholesterol and peripheral vasomotor function
Jeffrey T Kuvin1, Ayan R Patel, Mandeep Sidhu
1Department of Medicine/Division of Cardiology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA. jkuvin@tufts-nemc.org
Insights
Low high-density lipoprotein (HDL) cholesterol is linked to impaired endothelial function, a key factor in atherosclerosis. This study found a direct correlation between HDL levels and blood vessel vasodilation, suggesting a novel mechanism for cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Vascular Biology
Background:
- Low high-density lipoprotein (HDL) cholesterol is a common lipid abnormality in patients with coronary artery disease (CAD).
- Endothelial dysfunction, characterized by impaired endothelium-dependent vasomotion, is also highly prevalent in CAD patients.
- The relationship between HDL cholesterol levels and peripheral endothelial function in individuals evaluated for atherosclerosis remains unclear.
Purpose of the Study:
- To investigate the correlation between high-density lipoprotein (HDL) cholesterol levels and endothelium-dependent vasomotion in patients undergoing evaluation for atherosclerosis.
- To determine if HDL cholesterol is an independent predictor of peripheral endothelial function.
Main Methods:
- Peripheral vascular endothelial function was assessed using high-resolution brachial artery ultrasound to measure flow-mediated dilation (FMD).
- FMD was defined as the percent change in arterial diameter following 5-minute arterial occlusion.
- All 151 subjects underwent stress testing with nuclear single-photon emission computed tomographic imaging to assess left ventricular ejection fraction and diagnose coronary artery disease.
Main Results:
- Subjects with HDL cholesterol <40 mg/dl (n=39) exhibited significantly lower FMD (7.4±3.6%) compared to those with HDL cholesterol ≥40 mg/dl (11.0±5.5%, p<0.001).
- A significant positive correlation was observed between FMD and HDL cholesterol levels (p<0.001).
- Multivariate analysis identified HDL cholesterol as an independent predictor of FMD, indicating impaired endothelial function in subjects with low HDL.
Conclusions:
- Peripheral endothelial function is impaired in individuals with low HDL cholesterol and well-preserved in those with high HDL cholesterol.
- Impaired endothelial function associated with low HDL cholesterol may represent a previously unrecognized mechanism contributing to the elevated risk of atherosclerosis.
- These findings highlight the importance of HDL cholesterol in maintaining vascular health and suggest potential therapeutic targets for atherosclerosis prevention.
Abstract:
Low levels of high-density lipoprotein (HDL) cholesterol are one of the most common lipid abnormalities in patients with coronary artery disease. Endothelial dysfunction is also highly prevalent in patients with coronary artery disease. We sought to determine whether HDL cholesterol levels are correlated with endothelium-dependent vasomotion in patients being evaluated for atherosclerosis. Peripheral vascular endothelial function was assessed by high-resolution brachial artery ultrasound. Flow-mediated dilation (FMD) during reactive hyperemia was defined as the percent change in arterial diameter following 5-minute arterial occlusion. All patients underwent stress testing with nuclear single-photon emission computed tomographic imaging to determine percent left ventricular ejection fraction and define the presence or absence of coronary artery disease. One hundred fifty-one subjects (87 men, 64 women) were enrolled (average age 58 +/- 11 years). Total cholesterol, HDL cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were 188 +/- 48, 47 +/- 13, 108 +/- 37 and 154 +/- 88 mg/dl, respectively. The mean FMD for the entire group was 9.9 +/- 5.2%. Subjects with an HDL cholesterol of <40 mg/dl (n = 39) had lower FMD (7.4 +/- 3.6%) compared with those with an HDL cholesterol >/=40 mg/dl (11.0 +/- 5.5%, p <0.001). There was a significant correlation between FMD and HDL cholesterol level (linear regression, p <0.001), and in multivariate analysis, HDL cholesterol was an independent predictor of FMD. Peripheral endothelial function was abnormal in subjects with low HDL cholesterol and well-preserved in those with high HDL cholesterol. These data suggest that impaired endothelial function associated with low HDL cholesterol may be an additional, previously unrecognized mechanism contributing to the increased risk of atherosclerosis in these patients.