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Published on: June 16, 2014
Association between vascular endothelial dysfunction and the inflammatory marker neopterin in patients with classic
Hekma Saad Farghaly1, Kotb Abbass Metwalley1, Duaa Mohamed Raafat1
1Department of Pediatrics, Faculty of Medicine, Assiut University, Asyut, Egypt.
Insights
Congenital adrenal hyperplasia (CAH) patients exhibit endothelial dysfunction, an early vascular issue. This dysfunction is linked to elevated neopterin (NP) levels, indicating inflammation
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Immunology
Background:
- Congenital adrenal hyperplasia (CAH) patients face heightened risks of cardiometabolic complications.
- Endothelial dysfunction is a recognized early vascular abnormality in CAH.
Purpose of the Study:
- To assess vascular endothelial dysfunction in CAH patients.
- To investigate the association between endothelial dysfunction and serum neopterin (NP) levels in CAH.
Main Methods:
- 40 CAH patients and 40 healthy controls were compared.
- Vascular ultrasound measured brachial artery flow-mediated dilation (FMD%) and carotid intima-media thickness (CA-IMT).
- Serum neopterin (NP) levels, HOMA-IR, and hs-CRP were analyzed.
Main Results:
- CAH patients showed significantly lower FMD% and higher NP levels compared to controls.
- FMD% was significantly correlated with NP, hs-CRP, HOMA-IR, and CA-IMT.
- Neopterin (NP) emerged as the strongest independent predictor of FMD%.
Conclusions:
- CAH patients exhibit endothelial dysfunction, an early stage of vascular disease.
- Elevated NP levels are significantly associated with endothelial dysfunction in CAH.
- Inflammation, indicated by NP, likely plays a key role in CAH-related vascular damage.
Background And Aims:
Patients with congenital adrenal hyperplasia (CAH) are at increased risk of cardiometabolic abnormalities. We aimed to evaluate vascular endothelial dysfunction and its association with serum neopterin (NP) levels in CAH patients.
Methods:
The study included 40 patients, with a mean age of 14.8 ± 2.6 years; 28 (70%) subjects were females. They were compared with 40 healthy controls matched in anthropometric evaluation and measurement of fasting lipids, glucose, insulin, homeostasis model assessment for insulin resistance [HOMA-IR], and serum NP levels (nmol/L). Vascular ultrasound was used to measure brachial artery flow-mediated dilation (FMD%) and carotid intima-media thickness (CA-IMT). According to the degree of control on medical treatment, patients were classified into poor (n = 12) and good (n = 28) control groups.
Results:
Compared to controls, CAH patients had lower brachial FMD% (4.60 ± 2.13 versus 9.31 ± 2.29, p = 0.001), similar CA-IMT (0.44 ± 0.08 versus 0.44 ± 0.06, p = nonsignificant) and higher NP (42.6 ± 11.6 versus 9.2 ± 3.8, p = 0.001). However, differences between poor and good control CAH patients were significant regarding FMD%, CA-IMT, and NP measurements. FMD% correlated significantly with NP (r = -0.54, p = 0.001), high-sensitivity CRP (r = -0.53, p = 0.001), HOMA-IR (r = -0.31, p = 0.01), CA-IMT (r = -0.22, p < 0.05), diastolic blood pressure (r = 0.32, p = 0.01) and systolic blood pressure (r = -0.022, p < 0.05). NP was the most significant independent predictor of FMD%, as determined by linear regression analysis (p = 0.001).
Conclusions:
Our study showed that CAH patients had endothelial dysfunction, which is an early process of vascular affection. This was significantly associated with NP levels, suggesting a crucial role of inflammation in the pathogenesis of vascular damage. Further studies are needed to confirm our findings and to investigate the exact role of NP, as either protective or proatherothrombotic.
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