Relation of vasodilator response of the brachial artery to inflammatory markers in patients with coronary artery disease.
Endothelial dysfunction of the coronary artery is closely related to elevated levels of systemic inflammatory markers and cardiovascular events in patients with coronary artery disease (CAD). We hypothesized that patients with CAD may have a higher risk of endothelial dysfunction of the peripheral artery than patients without evidence of CAD, and that endothelial dysfunction of the peripheral artery also may be related to elevated levels of inflammatory markers. Using high resolution ultrasound, we assessed the brachial vasodilator response to reactive hyperemia (endothelium-dependent) and sublingual nitroglycerin (endothelium-independent). As inflammatory markers, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels, and lipid profiles were measured in patients with CAD (n = 30, 16 male and 14 female) and normal subjects without evidence of CAD (n = 45, 23 male and 22 female). Patients with CAD (Group II) showed a significantly reduced endothelium-dependent vasodilation as compared with normal subjects (Group I) (4.4 +/- 3.6 vs 7.4 +/- 6.1%, P < 0.05). However, endothelium-independent vasodilation was not significantly different between the two groups (7.7 +/- 7.1 vs 9.7 +/- 8.0%, P > 0.05). In Group II, CRP level was inversely related to endothelium-dependent vasodilation (r = -0.398, P = 0.029). In contrast, ESR level was not significantly associated to endothelium-dependent vasodilation (r = -0.113, P = 0.552). On multivariate analysis, CRP and low density lipoprotein cholesterol levels were significant independent predictors of a blunted endothelium-dependent vasodilation in Group II. Our study showed that elevated CRP level was associated with blunted endothelium-dependent vasodilation of the brachial artery in patients with CAD. Thus, identification of elevated CRP levels combined with demonstration of endothelial dysfunction of the brachial artery may have a possible clinical application for the detection of high risk CAD patients.
Kang
Seok-Min
SM
Cardiology Division, Yonsei Cardiovascular Center, Yonsei University College of Medicine, 134, Shinchon-Dong, Seodaemun-Gu, Seoul 120-752, Korea. namsikc@yumc.yonsei.ac.kr
Chung
Namsik
N
Kim
Ji-Young
JY
Koo
Bon-Kwon
BK
Choi
Donghoon
D
Jang
Yangsoo
Y
Cho
Seung-Yun
SY
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001799:Blood Sedimentation; D001916:Brachial Artery / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D005996:Nitroglycerin / Q000008:administration & dosage; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology*; D014665:Vasodilator Agents / Q000008:administration & dosage
D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D018836:Inflammation Mediators; D014665:Vasodilator Agents; D002097:C-Reactive Protein; D005996:Nitroglycerin