Global vasomotor dysfunction and accelerated vascular aging in beta-thalassemia major.
BACKGROUND
Patients with beta-thalassemia major (beta-TM) demonstrate an increased incidence of vascular complications, which are thought to result from a procoagulant/proinflammatory environment. We investigated the arterial vasorelaxing capacity and sought for early carotid atherosclerosis and underlying pathophysiological correlates in these transfusion-dependent patients.


RESULTS
The vasodilatory properties of the brachial artery and the carotid intima-media thickness (IMT) were examined with ultrasonography in 35 non-diabetic young adults with beta-TM (patient group) and 35 control subjects (control group). Among thalassemic patients, both endothelium-dependent (FMD) and -independent dilatation (FID) as well as their ratio was impaired, whereas IMT was increased (p<0.01). Patients on optimal, as compared with those on non-optimal chelation treatment had a non-significantly lower IMT. Vasodilatory capacity in the patient group was inversely correlated with IMT and independently associated either with the quality of chelation therapy (FMD) or serum ferritin levels (FID). Plasma concentrations of D-dimers, circulating markers of endothelial activation, inflammation and apoptosis were higher, while plasma cholesterol and fibrinogen levels were lower-than-normal in the patient group. Independent predictors of IMT among thalassemic patients were tumor necrosis factor-alpha levels and age.


CONCLUSIONS
Young adults with beta-TM exhibit both a global impairment of arterial vasorelaxation and early carotid atherosclerosis. A procoagulant/proinflammatory state in these transfusion-dependent patients may overwhelm atheroprotective mechanisms, including an optimal chelation regimen, and promote vascular injury and atherogenesis.
Hahalis
George
G
Department of Cardiology, University Hospital of Patras, Greece. ghahalis@otenet.gr
Kremastinos
Dimitrios T
DT
Terzis
George
G
Kalogeropoulos
Andreas P
AP
Chrysanthopoulou
Athina
A
Karakantza
Marina
M
Kourakli
Alexandra
A
Adamopoulos
Stamatis
S
Tselepis
Alexandros D
AD
Grapsas
Nikos
N
Siablis
Dimitrios
D
Zoumbos
Nicholas C
NC
Alexopoulos
Dimitrios
D
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D014463:Ultrasonography; D014664:Vasodilation; D014666:Vasomotor System / Q000503:physiopathology*; D017086:beta-Thalassemia / Q000150:complications / Q000473:pathology / Q000503:physiopathology*
D015415:Biomarkers