Weingärtner Oliver, Weingärtner Nadja, Scheller Bruno, Lütjohann Dieter, Gräber Stefan, Schäfers Hans-Joachim, Böhm Michael, Laufs Ulrich
Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Coron Artery Dis. 2009 Sep;20(6):376-82. doi: 10.1097/MCA.0b013e32832fa947.
Hypercholesterolemia is a risk factor for aortic stenosis (AS) and for coronary artery disease (CAD). Serum cholesterol concentrations are determined by intestinal cholesterol absorption and endogenous cholesterol synthesis. Vascular effects of differences in cholesterol metabolism in patients with AS are so far unknown. Therefore, the aim of this study was to investigate differences in cholesterol metabolism in relation to vascular diseases in this subset of patients.
In addition to identifying conventional coronary risk factors, we determined plant sterols (indicators of cholesterol absorption) and lathosterol (indicator of cholesterol synthesis) levels in 40 consecutive men and women with AS. Coronary angiograms before the aortic valve replacement determined the extent of CAD.
Patients with a positive history of cardiovascular disease exhibited an increased campesterol-to-lathosterol ratio in plasma (P<0.005) and in aortic valve cusps (P<0.05). The plasma campesterol-to-lathosterol ratio increased with CAD severity (zero, single, two, three-vessel disease; P<0.05). Coronary vessel score strongly correlated with the campesterol-to-lathosterol ratio in plasma (r = 0.52; P<0.001) and in aortic valve cusps (r = 0.33; P<0.03). Logistic regression analysis revealed that the ratio of campesterol-to-lathosterol was the sole predictor of CAD among coronary risk factors tested (P<0.01).
Enhanced absorption and reduced synthesis of cholesterol is related to a positive family history of cardiovascular diseases and the development of concomitant CAD in patients with AS.
高胆固醇血症是主动脉瓣狭窄（AS）和冠状动脉疾病（CAD）的危险因素。血清胆固醇浓度由肠道胆固醇吸收和内源性胆固醇合成决定。目前尚不清楚AS患者胆固醇代谢差异的血管效应。因此，本研究的目的是调查这一亚组患者中与血管疾病相关的胆固醇代谢差异。
除了确定传统的冠状动脉危险因素外，我们还测定了40例连续的AS男性和女性患者的植物甾醇（胆固醇吸收指标）和羊毛甾醇（胆固醇合成指标）水平。主动脉瓣置换术前的冠状动脉造影确定了CAD的程度。
有心血管疾病阳性病史的患者血浆中菜油甾醇与羊毛甾醇的比值升高（P<0.005），主动脉瓣叶中该比值也升高（P<0.05）。血浆中菜油甾醇与羊毛甾醇的比值随CAD严重程度增加而升高（无病变、单支血管病变、两支血管病变、三支血管病变；P<0.05）。冠状动脉血管评分与血浆中菜油甾醇与羊毛甾醇的比值密切相关（r = 0.52；P<0.001），与主动脉瓣叶中该比值也密切相关（r = 0.33；P<0.03）。逻辑回归分析显示，在测试的冠状动脉危险因素中，菜油甾醇与羊毛甾醇的比值是CAD的唯一预测指标（P<0.01）。
胆固醇吸收增加和合成减少与AS患者心血管疾病的阳性家族史及并发CAD的发生有关。
