title: Microvascular function, metabolic syndrome, and novel risk factor status in women with cardiac syndrome X.
abstract: To characterize microvascular function, candidate risk pathways, and metabolic syndrome prevalence in women with cardiac syndrome X, 52 nondiabetic women with angiographically normal epicardial arteries but >1 mm of planar ST depression during exercise testing (patients) and 24 healthy controls of similar age were recruited. In addition to fasting blood samples and anthropometric measurements, forearm cutaneous microvascular function after iontophoresis of acetylcholine and sodium nitroprusside was assessed by laser Doppler imaging. Despite body mass index correction and a larger proportion on statin therapy, patients had high levels of insulin (p=0.016), triglycerides (p=0.018), intercellular adhesion molecule-1 (p=0.021), von Willebrand factor (p=0.005), and leptin (p=0.005) and lower levels of high-density lipoprotein cholesterol (p=0.042) compared with controls. Consistent with these data, 30% of patients but only 8% of controls fulfilled criteria for the metabolic syndrome as defined by the National Cholesterol Education Program (p=0.015). Endothelium-dependent and -independent microvascular functions were markedly impaired in patients (p<0.001), and the odds ratio for cardiac syndrome X was 7.38 (95% confidence interval 2.2 to 24.7) if the acetylcholine response was <8,710 flux units. In conclusion, women with cardiac syndrome X more commonly have metabolic syndrome and related adiposity, metabolic, and inflammatory derangements. They also have significantly impaired skin microvascular function as assessed by laser Doppler imaging, consistent with generalized vascular dysfunction, a finding with potential diagnostic implications.
authors.affiliation: The Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom. stjadhav@bigfoot.com
authors.forename: Sachin T
authors.initials: ST
authors.lastname: Jadhav
authors.forename: William R
authors.initials: WR
authors.lastname: Ferrell
authors.forename: John R
authors.initials: JR
authors.lastname: Petrie
authors.forename: Olga
authors.initials: O
authors.lastname: Scherbakova
authors.forename: Ian A
authors.initials: IA
authors.lastname: Greer
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Cobbe
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
mesh_terms: D000109:Acetylcholine; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D005080:Exercise Test; D005260:Female; D006801:Humans; D007328:Insulin / Q000097:blood; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D007478:Iontophoresis; D017078:Laser-Doppler Flowmetry; D020738:Leptin / Q000097:blood; D024821:Metabolic Syndrome / Q000097:blood* / Q000150:complications; D008833:Microcirculation; D017566:Microvascular Angina / Q000097:blood* / Q000150:complications; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D012867:Skin / Q000098:blood supply*; D014280:Triglycerides / Q000097:blood; D014665:Vasodilator Agents; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D007328:Insulin; D020738:Leptin; D014280:Triglycerides; D014665:Vasodilator Agents; D014841:von Willebrand Factor; D018799:Intercellular Adhesion Molecule-1; D000109:Acetylcholine