Schnell G B, Robertson A, Houston D, Malley L, Anderson T J
Department of Medicine, University of Calgary, Alberta, Canada.
J Am Coll Cardiol. 1999 Jun;33(7):2038-43. doi: 10.1016/s0735-1097(99)00104-7.
The purpose of this study was to determine if patients with modest hyperlipidemia, and no other risk factors for coronary artery disease (CAD), have impaired endothelium-dependent (ED) vasoactivity.
Hypercholesterolemia impairs ED vasodilation, but the impact of elevated triglycerides on endothelial function is not as well established.
High-resolution ultrasound was used to determine flow-mediated dilation (FMD) in the brachial artery (BA) after a 5-min arterial occlusion (endothelium-dependent stimulus) and nitroglycerin-induced dilation (endothelium-independent stimulus). We studied 40 healthy controls (Group 1), 38 patients with elevated low-density lipoprotein (LDL) cholesterol (Group 2) and 35 patients with elevated triglycerides (Group 3). Patients were excluded if they had known CAD or other risk factors for CAD, or if they were receiving lipid-lowering or vasoactive medications.
Control patients (Group 1) had normal LDL cholesterol (2.6+/-0.8 mmol/liter) and triglyceride levels (1.0+/-0.5 mmol/liter) compared with Group 2 (5.2+/-1.2 mmol/liter, 1.8+/-0.6 mmol/liter) and Group 3 (3.5+/-0.9 mmol/liter, 4.2+/-2.5 mmol/liter) subjects (p < 0.001). Baseline BA diameters were the same across the three groups. There was no significant attenuation of flow-mediated vasodilation (FMD) in either of the hyperlipidemic groups (Group 1: 10.9+/-5.0% vs. Group 2: 8.6+/-6.1% vs. Group 3: 9.4+/-3.9%; p = 0.14). However, nitroglycerin-induced vasodilation was mildly reduced (Group 1: 21.0+/-5.0% vs. 16.9+/-7.6% vs. 17.3+/-7.7%; p = 0.01). By multivariate analysis, after controlling for baseline diameters, only the ratio of LDL/high-density lipoprotein predicted a minor impairment in FMD.
In patients free from other cardiac risk factors, modest elevations of triglycerides or LDL cholesterol do not significantly attenuate BA endothelial-dependent vasodilation. Synergism with other cardiac risk factors may be required to significantly impair endothelial function in these patients.
本研究旨在确定患有轻度高脂血症且无其他冠状动脉疾病（CAD）危险因素的患者是否存在内皮依赖性（ED）血管活性受损。
高胆固醇血症会损害ED血管舒张功能，但甘油三酯升高对内皮功能的影响尚未完全明确。
使用高分辨率超声在5分钟动脉闭塞（内皮依赖性刺激）和硝酸甘油诱导的舒张（非内皮依赖性刺激）后测定肱动脉（BA）的血流介导舒张（FMD）。我们研究了40名健康对照者（第1组）、38名低密度脂蛋白（LDL）胆固醇升高的患者（第2组）和35名甘油三酯升高的患者（第3组）。如果患者已知患有CAD或其他CAD危险因素，或正在接受降脂或血管活性药物治疗，则将其排除。
与第2组（5.2±1.2 mmol/升，1.8±0.6 mmol/升）和第3组（3.5±0.9 mmol/升，4.2±2.5 mmol/升）受试者相比，对照患者（第1组）的LDL胆固醇（2.6±0.8 mmol/升）和甘油三酯水平（1.0±0.5 mmol/升）正常（p<0.001）。三组的基线BA直径相同。在任何一组高脂血症患者中，血流介导的血管舒张（FMD）均无显著减弱（第1组：10.9±5.0% vs.第2组：8.6±6.1% vs.第3组：9.4±3.9%；p = 0.14）。然而，硝酸甘油诱导的血管舒张略有降低（第1组：21.0±5.0% vs. 16.9±7.6% vs. 17.3±7.7%；p = 0.01）。通过多变量分析，在控制基线直径后，只有LDL/高密度脂蛋白比值预测FMD有轻微损害。
在没有其他心脏危险因素的患者中，甘油三酯或LDL胆固醇的适度升高不会显著减弱BA内皮依赖性血管舒张。可能需要与其他心脏危险因素协同作用才能显著损害这些患者的内皮功能。
Zotero 插件