Coronary atherosclerotic wall thickening and vascular reactivity in humans. Elevated high-density lipoprotein levels ameliorate abnormal vasoconstriction in early atherosclerosis.
Why the study?
Do elevated HDL cholesterol levels ameliorate abnormal coronary vasoconstriction associated with early atherosclerosis in patients without focal stenoses?
Population
26 patients without focal stenoses in the left anterior descending coronary artery
Comparison
Intracoronary acetylcholine infusion and cold… vs Comparison between patients with elevated HDL…
Design
Cross-sectional
Authors
Discussion
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Implication
Elevated HDL may blunt vasoconstriction in early atherosclerosis; leaves open whether HDL modulation improves vasomotor function or outcomes.
Key Points
- To determine whether coronary atherosclerotic wall thickening impairs endothelium-mediated vasodilation and to assess whether elevated high-density lipoprotein levels mitigate this abnormal vasomotor response in vivo.
- Assessed 26 patients without focal left anterior descending coronary artery stenoses using intracoronary ultrasound to quantify local atherosclerotic wall thickening.
- Infused acetylcholine (0.036 to 3.6 µg/mL) to evaluate endothelium-dependent vasodilation, and conducted cold pressor testing in 17 patients to evaluate sympathetic reactivity.
- Segmental vasomotor responses to acetylcholine ranged from 35% dilation to 52% constriction and correlated strongly with local wall thickening (r = -0.82, P < 0.0001).
- Patients with high-density lipoprotein cholesterol levels above the 75th percentile showed significantly blunted vasoconstriction to acetylcholine (P < 0.01) and cold pressor testing (P < 0.05) across all degrees of wall thickening.
- Vasomotor responses to acetylcholine strongly correlated with responses induced by cold pressor sympathetic stimulation (r = 0.75, P < 0.0001).
Structured PICO
Do elevated HDL cholesterol levels ameliorate abnormal coronary vasoconstriction associated with early atherosclerosis in patients without focal stenoses?
P
Population
26 patients without focal stenoses in the left anterior descending coronary artery
I
Intervention
Intracoronary acetylcholine infusion (0.036 to 3.6 micrograms/mL) and cold pressor testing (in 17 patients) to evaluate vasoreactivity, with atherosclerotic wall thickening quantitated by intracoronary ultrasound
C
Comparator
Comparison between patients with elevated HDL cholesterol serum levels (> 75th percentile) and patients with HDL cholesterol < 75th percentile
O
Outcome
Segmental vasomotor responses to acetylcholine correlated with the local extent of atherosclerotic wall thickeningsurrogate
Elevated HDL cholesterol levels are associated with a blunted abnormal vasoconstrictor response in early coronary atherosclerosis, suggesting a protective functional role for HDL on vascular reactivity.
Cite This Study
Zeiher et al. (1994) studied this question.