Endothelial dysfunction
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Metabolic syndrome correlates with endothelial dysfunction of coronary microvasculature in patients with normal coronary arteries.
Teragawa H, Ueda A, Takemoto H, et al. How does the metabolic syndrome score affect coronary microvascular endothelial function? Circulation 2005;112(Suppl):II-708. Abstract 3314.
H. Teragawa et al (Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan) investigated the relationship between endothelial dysfunction and the metabolic syndrome in 70 patients presenting with chest pain but angiographically normal coronary arteries. Patients with vasospastic angina, previous myocardial infarction or heart failure were excluded.
Using the ATP III definition of metabolic syndrome, the researchers calculated a metabolic syndrome (MS) score, ranging from 0 to 5, corresponding to the number of components of the syndrome present in each subject of their study. The table shows the distribution of MS scores.
|
MS score
|
Number of patients (%)
|
|
0
|
9 (13%)
|
|
1
|
19 (27%)
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|
2
|
23 (33%)
|
|
3
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15 (21%)
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4
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4 (6%)
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5
|
0
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All subjects received an infusion of acetylcholine (known to induce endothelium-dependent vasodilation) followed by an infusion of nitroglycerin (inducing endothelium-independent vasodilation). Coronary blood flow was calculated by quantitative angiography and Doppler flow velocity measurements.
The MS score correlated inversely with the increase in coronary blood flow in response to the infusion of acetylcholine (r = 0.4642; P<0.0001). Multivariate analysis identified 3 independent predictors of endothelial dysfunction: MS score (P=0.0005), decreased coronary flow reserve (P=0.006), and increased C-reactive protein levels (P<0.05), a component of the metabolic syndrome not listed in the ATP III definition (r2=0.36).
These findings suggest that the number of metabolic syndrome components aggregating in individuals with chest pain but normal coronary arteries correlates with the severity of coronary microvascular endothelial dysfunction. The authors propose to use the MS score as a surrogate end-point of clinical outcome in such patients.
