Evaluation of the relationship between flow-mediated vasodilation and some atherogenic risk markers in severe
Ljudmila G Vladimirova-Kitova1, Ivan H Manukov, Ivanka Sirakova
1Clinic of Cardiology, Medical University, Plovdiv, Bulgaria.
Insights
Severe hypercholesterolemia significantly impairs endothelial function, evidenced by reduced flow-mediated vasodilation. Asymmetric dimethylarginine and apoprotein B are key predictors of this dysfunction.
Area of Science:
- Cardiovascular research
- Preventive cardiology
- Endothelial function studies
Background:
- Focus on primary prevention in high-risk patients with severe hypercholesterolemia.
- Limited data on asymmetric dimethylarginine (ADMA) levels in severe hypercholesterolemia.
- Scarcity of information on flow-mediated vasodilation (FMD) correlation with atherogenic risk biomarkers.
Purpose of the Study:
- To evaluate the relationship between FMD and lipids, apoproteins, and endothelial activation markers in severe hypercholesterolemia.
- To investigate ADMA levels in patients with severe hypercholesterolemia compared to controls.
- To explore correlations between FMD and specific biomarkers.
Main Methods:
- Study included 58 patients with severe hypercholesterolemia (> 7.5 mmol/l) and 50 healthy controls.
- Patients were asymptomatic and diagnosed using Simon-Broome criteria for familial hypercholesterolemia.
- Measurements included lipid profile, apoproteins, ADMA, and FMD.
Main Results:
- Patients with severe hypercholesterolemia exhibited significantly higher lipid profiles, apoproteins, and ADMA levels (P < 0.0001).
- Flow-mediated vasodilation was significantly lower in patients (4.49%) compared to controls (8.64%) (P < 0.001).
- Strong negative correlations were found between FMD and ADMA (r = -0.895), apoprotein B (r = -0.687), and apoB/apoA-I ratio (r = -0.518) (all P < 0.0001).
Conclusions:
- Asymmetric dimethylarginine levels explain 80% of the variation in flow-mediated vasodilation.
- ADMA, apoprotein B, and apoB/apoA-I ratio are strongly associated with endothelial dysfunction in severe hypercholesterolemia.
- These biomarkers are more indicative of early endothelial dysfunction than traditional lipid profile components.
Background:
In recent years, there has been a shift of interest in preventive cardiology towards primary prevention in high risk patients such as the patients with severe hypercholesterolemia. There is scanty information available in the respective literature on the levels of asymmetric dimethylarginine in severe hypercholesterolemia and on the correlation of flow-mediated vasodilation with some atherogenic risk biomarkers.
Aim:
To assess the relationship of flow-mediated vasodilation with lipids, apoproteins and some serum markers of endothelial activation in severe hypercholesterolemia.
Patients And Methods:
The study population consisted of 58 patients with severe hypercholesterolemia (> 7.5 mmol/l) as categorised by Simon-Broome's criteria for clinical definite and probable diagnosis of familial hypercholesterolemia. All patients were asymptomatic. The study included also 50 control subjects that had no evidence of hypercholesterolemia.
Results:
The analysis of the lipid profile, the atherogenic lipid indices, and the apoproteins of patients and controls supports the alternative hypothesis: there is a statistically significant difference determined by the higher values of these parameters in the patients group (P < 0.0001). The mean values of asymmetric dimethylarginine calculated at baseline in both groups differed significantly (1.64 +/- 0.04 micromol/l vs. 0.47 +/- 0.02 micromol/l for patients and controls, respectively, P < 0.001). There was also a significant difference in the mean values of flow-mediated vasodilation calculated at baseline between the two groups (4.49 +/- 0.62% vs. 8.64 +/- 0.61% for patients and controls, respectively, P < 0.001). We found a very strong negative correlation, which reached statistical significance, between the flow-mediated vasodilation and the asymmetric dimethylarginine, apoprotein B and the apoprotein B/apoprotein A-I ratio (rxy = -0.687 with apoprotein B, p < 0.0001; rxy = -0.518 with apoprotein B/apoprotein A-I ratio, p < 0.0001; and rxy = -0.895 with asymmetric dimethylarginine, p < 0.0001).
Conclusions:
Univariate analysis showed that 80% of all variations in the values of flow-mediated vasodilation can be explained by variations in the values of asymmetric dimethylarginine. The significant negative correlation between the flow-mediated vasodilation and apoprotein B, the apoprotein B/apoprotein A-I ratio and the asymmetric dimethylarginine indicates that these biomarkers are more strongly associated with the endothelial dysfunction (the earliest functional abnormality of the vascular wall) than with the lipid profile components that are usually used in clinical practice.
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