title: Obesity and statins are both independent predictors of enhanced coronary arteriolar dilation in patients undergoing heart surgery.
abstract: BACKGROUND
  A paradoxical inverse relationship between body mass index, morbidity and mortality in patients with ischemic heart disease has been noted; but the underlying mechanisms remain unclear. Given that coronary resistance arteries are the primary regulators of myocardial blood flow, we examined the effects of obesity and medication on dilator function in coronary microvessels.
  
  
  METHODS
  Bradykinin-induced coronary dilation was assessed by videomicroscopy in ex vivo coronary arterioles obtained from 64 consecutive patients undergoing heart surgery. Multi-variable linear regression and logistic regression were used to investigate the effects of obesity (BMI ≥ 30 kg/M2) and the influences of medications on vessel responses.
  
  
  RESULTS
  In isolated, pressurized (80 mmHg) coronary arterioles of obese and non-obese patient the active (73±4 vs. 79±13 μm) and passive (111 ± 5.5 vs. 118 ± 5.0 μm) diameters were similar. Bradykinin elicited substantial dilation in coronary arterioles, with a similar magnitude in obese and non-obese patients (to 10-8 M: 55 ± 5% vs. 46 ± 5%, P = 0.20), but with significantly enhanced sensitivity in obesity (EC50: 8.2x10-9 M vs. 1.9x10-8 M, respectively, P = 0.03). When adjusted for other risk factors and medications, obesity and statins were determined to be the only positive predictors of enhanced dilation, as assessed with multiple regression analysis. Moreover, obese patients with or without statin exhibited significantly increased coronary dilation to bradykinin, when compared to non-obese patients without statin therapy.
  
  
  CONCLUSIONS
  Obesity and statin therapy are independently associated with an enhanced dilator function of coronary arterioles in patients undergoing heart surgery, which may offer a potential mechanism for the better cardiovascular outcome described earlier as the obesity paradox.
authors: James
authors: J
authors: Cassuto
authors: Attila
authors: A
authors: Feher
authors: Ling
authors: L
authors: Lan
authors: Vijay S
authors: VS
authors: Patel
authors: Vinayak
authors: V
authors: Kamath
authors: Daniel C
authors: DC
authors: Anthony
authors: Zsolt
authors: Z
authors: Bagi
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001920:Bradykinin / Q000494:pharmacology; D006348:Cardiac Surgical Procedures; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D066298:In Vitro Techniques; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D018715:Microscopy, Video; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D012044:Regression Analysis; D012307:Risk Factors; D014664:Vasodilation / Q000187:drug effects* / Q000502:physiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001920:Bradykinin
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