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Coronary endothelial dysfunction and impaired microcirculation response to atrial natriuretic peptide in

Takashi Ashikaga1, Mitsuhiro Nishizaki, Hiroyuki Fujii

  • 1Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama City, Kanagawa 236-0037, Japan. ashikaga-ind@umin.ac.jp

Journal of Cardiovascular Pharmacology and Therapeutics
|February 22, 2008
PubMed

Insights

Hyperinsulinemia (HI) is linked to endothelial dysfunction. In patients with HI, atrial natriuretic peptide response in coronary microcirculation is significantly blunted, suggesting a pathological effect even in mild cases.

Area of Science:

  • Cardiology
  • Endocrinology
  • Vascular Biology

Background:

  • Endothelial dysfunction is a known complication of hyperinsulinemia (HI).
  • Assessing coronary microcirculation responses to vasoactive agents is crucial for understanding vascular health in patients with normal coronary arteries.

Purpose of the Study:

  • To investigate coronary microcirculation responses to various vasoactive agents in patients with normoinsulinemia (NI) versus hyperinsulinemia (HI).
  • To evaluate the impact of HI on endothelial function and microvascular reactivity.

Main Methods:

  • 57 patients with angiographically normal coronary arteries were divided into NI (n=37) and HI (n=20) groups based on an oral glucose tolerance test.
  • Epicardial artery vasoactivity was assessed using acetylcholine chloride.
  • Coronary microcirculation function was evaluated via intracoronary administration of adenosine triphosphate, isosorbide dinitrate, and atrial natriuretic peptide.

Main Results:

  • Epicardial artery vasoconstriction to acetylcholine was mildly reduced in the HI group (P = .04).
  • Coronary flow reserve to adenosine triphosphate was similar between NI and HI groups.
  • In the HI group, the response of peak velocity to atrial natriuretic peptide was significantly blunted compared to isosorbide dinitrate (P < .001), unlike in the NI group.

Conclusions:

  • Hyperinsulinemia is associated with mild endothelial dysfunction affecting epicardial arteries.
  • Atrial natriuretic peptide response is significantly impaired in the coronary microcirculation of patients with HI, even with mild endothelial dysfunction.
  • These findings suggest a potential pathological role for atrial natriuretic peptide in HI-related microvascular impairment.

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