Instituto do Coração (InCor), Universidade de São Paulo, São Paulo, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Universidade Federal da Paraíba, João Pessoa, Brazil.
Eur J Clin Invest. 2013 Dec;43(12):1291-8. doi: 10.1111/eci.12177. Epub 2013 Oct 15.
Hypercholesterolaemia may alter cardiovascular autonomic function. We investigated the autonomic cardiovascular regulation during normoxia and hypoxia in familial isolated HC patients with or without statin treatment.
Low (LF-RR) and high (HF-RR) components of spectral analysis of RR interval and systolic arterial pressure (LF-SAP) were obtained during 5 min of normoxia and isocapnic hypoxia (10% O(2) ) in 10 normotensive familial HC patients without medication, in seven HC patients after a 12-week treatment period with 40 mg of simvastatin (HC + SVT) and in eight matched normal volunteers (CO).
The HC patients had significant impairment of cardiac autonomic modulation parameters compared with CO at normoxia, which was maintained or even accentuated during hypoxia; these parameters included lower total variance of RR, increased normalized LF-RR, decreased normalized HF-RR, increased LF-RR/HF-RR ratio, higher LF-SAP component and reduced α index. However, the HC + SVT group had a significant improvement in all parameters: the LF-RR and LF-SAP decreased (indicating a decrease in cardiac and vascular sympathetic activity), the HF-RR increased (indicating an increase in parasympathetic activity) and the spontaneous baroreflex sensitivity improved. These changes were detected at normoxia and were maintained during hypoxia.
Our data are the first to show that isolated HC is characterized by an increase in cardiac and vasomotor sympathetic drive, a decrease in cardiac vagal modulation and baroreflex impairment during normoxia and hypoxia. In addition, our data suggest that statin treatment has a potential role in restoring the physiological cardiovascular autonomic control at baseline and during cardiovascular challenge.
高胆固醇血症可能改变心血管自主功能。我们研究了家族性孤立性高胆固醇血症患者在接受或不接受他汀类药物治疗时，在常氧和低氧条件下自主心血管调节。
在 10 名未服用药物的正常血压家族性高胆固醇血症患者、7 名接受 40mg 辛伐他汀治疗 12 周的高胆固醇血症患者（高胆固醇血症+辛伐他汀组）和 8 名匹配的正常志愿者（对照组）中，分别在 5 分钟常氧和等碳酸低氧（10% O(2) ）条件下，通过 RR 间期和收缩压（LF-SAP）的频谱分析获得低频（LF-RR）和高频（HF-RR）成分。
与对照组相比，高胆固醇血症患者在常氧时心脏自主神经调节参数明显受损，在低氧时保持甚至加重；这些参数包括 RR 总方差降低、归一化 LF-RR 增加、归一化 HF-RR 降低、LF-RR/HF-RR 比值增加、LF-SAP 成分升高和α指数降低。然而，高胆固醇血症+辛伐他汀组在所有参数上均有显著改善：LF-RR 和 LF-SAP 降低（提示心脏和血管交感神经活动降低），HF-RR 增加（提示副交感神经活动增加），自主压力反射敏感性改善。这些变化在常氧时被检测到，并在低氧时保持。
我们的数据首次表明，孤立性高胆固醇血症的特征是在常氧和低氧条件下，心脏和血管交感神经驱动增加，心脏迷走神经调节和压力反射受损。此外，我们的数据表明，他汀类药物治疗可能在恢复基础和心血管挑战期间的生理心血管自主控制方面发挥作用。
