The association between saphenous vein endothelial function, systemic inflammation, and statin therapy in patients undergoing coronary artery bypass surgery.
OBJECTIVE
Endothelial dysfunction and C-reactive protein play a pivotal role in development of atherosclerosis and act as markers for future adverse cardiac events. Statins reduce C-reactive protein levels and improve endothelial function. However, little information is available on endothelial function and its determinants in veins. We investigated the association between saphenous vein endothelial function and C-reactive protein levels in patients treated with statins undergoing coronary artery bypass surgery.


METHODS
Seventy-six patients with optimal low-density lipoprotein cholesterol levels (< or =1.6 mmol/L) secondary to regular treatment with a minimum of simvastatin 40 mg were recruited. Each subject underwent detailed characterization according to anthropomorphic data, saphenous vein endothelial function (assessed ex vivo by measuring acetylcholine-induced relaxation of venous rings), and markers of systemic inflammation (C-reactive protein and tumor necrosis factor-alpha).


RESULTS
Despite regular treatment with statins, 26% of patients had C-reactive protein levels in the "high-risk" range (>3.0 mg/L). There was a negative linear correlation between acetylcholine-induced venous relaxation and C-reactive protein (r = -.30, P = .02) and waist circumference (r = -0.21, P = .03). In a multivariate regression model, C-reactive protein (P = .02) was the only independent predictor of acetylcholine-induced venous relaxation. In turn, correlates of C-reactive protein were assessed. There was a correlation between C-reactive protein and coronary atherosclerotic burden (r = .46, P < .0001), body mass index (r = .26, P = .03), fasting glucose levels (r = .31, P = .01), and waist circumference (r = .29, P = .01). Using multivariate analysis, coronary atherosclerotic burden (P < .0001) was the only independent predictor of C-reactive protein.


CONCLUSIONS
In our cohort of patients with coronary artery disease, C-reactive protein level was the only independent predictor of saphenous vein endothelial function. In turn, its levels were independently influenced by the extent of coronary atherosclerotic burden.
Cardiovascular Division, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, London, United Kingdom.
Aziz
A
Momin
Narbeh
N
Melikian
Stephen B
SB
Wheatcroft
David
D
Grieve
Lindsay C
LC
John
Ahmad
A
El Gamel
Michael T
MT
Marrinan
Jatin B
JB
Desai
Catherine
C
Driver
Roy
R
Sherwood
Ajay M
AM
Shah
Mark T
MT
Kearney
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000097:blood / Q000601:surgery*; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation / Q000097:blood; D008297:Male; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D012501:Saphenous Vein / Q000187:drug effects / Q000503:physiopathology / Q000637:transplantation*; D019821:Simvastatin / Q000627:therapeutic use*; D014654:Vascular Patency
D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein; D019821:Simvastatin