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Coronary flow reserve in hypertensive patients with hypercholesterolemia and without coronary heart disease
Maurizio Galderisi1, Giovanni de Simone, Silvana Cicala
1Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy. mgalderi@unina.it
Insights
In untreated hypertension, high total cholesterol (TC) and LDL-cholesterol are linked to reduced coronary flow reserve (CFR). This indicates impaired coronary vasodilator capacity is independently associated with cholesterol levels in these patients.
Area of Science:
- Cardiology
- Vascular Biology
- Hypertension Research
Background:
- Coronary flow reserve (CFR) can be diminished in arterial hypertension and hypercholesterolemia.
- The study investigates the relationship between CFR and plasma total cholesterol (TC) in individuals with untreated hypertension.
Purpose of the Study:
- To assess the association between coronary flow reserve (CFR) and plasma total cholesterol (TC) levels.
- To evaluate the impact of hypercholesterolemia on coronary vasodilator capacity in untreated hypertensive patients.
Main Methods:
- 54 untreated hypertensive outpatients were studied, divided into normal and high TC groups.
- Transthoracic Doppler echocardiography measured coronary diastolic peak velocities at rest and after dipyridamole administration.
- Coronary flow reserve (CFR) was calculated as the ratio of dipyridamole-induced to resting velocities.
Main Results:
- Patients with high TC exhibited higher systolic blood pressure and unfavorable lipid profiles (triglycerides, LDL-cholesterol, TC/HDL ratio).
- Coronary diastolic peak velocities post-dipyridamole were lower in the high TC group, resulting in a reduced CFR.
- Multiple regression analysis confirmed that TC and LDL-cholesterol independently predicted lower CFR, irrespective of other confounders.
Conclusions:
- In hypertensive patients without coronary artery disease, impaired coronary vasodilator capacity is significantly associated with plasma cholesterol levels.
- Elevated total cholesterol and LDL-cholesterol are independent predictors of reduced coronary flow reserve in this population.
Background:
Coronary flow reserve (CFR) may be reduced both in arterial hypertension and in hypercholesterolemia. The aim of the study was to assess an association between CFR and levels of plasma total cholesterol (TC) in untreated arterial hypertension.
Methods:
We studied 54 consecutive, untreated hypertensive outpatients free of coronary heart disease. Twenty of them had normal TC and 34 high TC (>/=200 mg/dL). Standard echocardiograms and transthoracic Doppler interrogation of the distal left anterior descending artery were obtained. Coronary diastolic peak velocities were measured both at rest and after low-dose dipyridamole. The CFR was calculated as dipyridamole/resting velocities ratio.
Results:
The two groups had similar age, body mass index, heart rate, and diastolic blood pressure (BP). Patients with high TC had higher systolic BP (P < .05), triglycerides (P < .02), LDL-cholesterol, and TC/HDL-cholesterol ratio (both P < .0001) than controls. Left ventricular (LV) mass index, relative wall thickness, and fractional shortening did not differ between the two groups. Coronary diastolic peak velocities were similar at rest but lower after dipyridamole in patients with high TC (P < .02). As a consequence, CFR was reduced (P < .002). In multiple linear regression analyses, adjusting for age, heart rate, systolic BP, smoking, and relative wall thickness, TC (beta = -0.338) or high LDL-cholesterol (beta = -0.301) (both P < .001) were predictors of lower CFR independently of the concomitant effect of potential confounders.
Conclusions:
In hypertensive patients free of coronary artery disease, the degree of impairment in coronary vasodilator capacity is independently associated with plasma cholesterol and LDL-cholesterol.
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