Microvascular Reactivity in Patients with
Hypercholesterolemia: Effect of Lipid Lowering Treatment
T. ŠTULC, Z. KASALOVÁ, M.
PRÁZNÝ, M. VRABLÍK, J. ŠKRHA, R. ČEŠKA
Third Department of Internal Medicine, First Faculty of
Medicine, Charles University, Prague, Czech Republic
Received July 4, 2002
Accepted September 30, 2002
Summary
Impaired NO-dependent vasodilation of resistance vessels is an
early marker of an increased risk of atherosclerosis; utility of
the examination of microcirculation, however, is far less
established. We have therefore tested the hypothesis that
hypercholesterolemia is associated with an impaired
microvascular reactivity and that this defect is at least
partially reversible by lipid-lowering treatment. Twenty-seven
otherwise healthy patients with severe hypercholesterolemia (HLP)
were examined at rest and then after 10 weeks of atorvastatin
treatment (20 mg/day). Skin microvascular reactivity (MVR) was
examined by laser-Doppler flowmetry. Baseline MVR values of the
studied group were compared to healthy control subjects, HLP
patients with coronary artery disease (CAD) and diabetic
patients with and without diabetic retinopathy. MVR was normal
in HLP subjects without CAD. On the contrary, MVR was impaired
in HLP patients with CAD. There was no effect of atorvastatin on
MVR, despite the profound reduction of serum lipids. MVR values
did not correlate with cholesterol levels. In diabetic subjects,
the MVR was substantially impaired only in patients with
retinopathy. In the subjects without retinopathy, MVR was either
normal (type I diabetes) or moderately impaired (type II
diabetes). MVR was thus normal in HLP patients without manifest
vascular disease and was not influenced by lipid lowering
therapy. Impairment in the MVR was only evident in subjects with
HLP and severe CAD. These results suggest that microcirculation
is not involved in the early vascular dysfunction induced by HLP
and that MVR rather reflects changes which appear later in the
course of the atherosclerotic disease.
Key
words
Hypercholesterolemia • Microcirculation • Cholesterol
lowering • Endothelial dysfunction • Laser-Doppler
Reprint
requests
Tomáš Štulc, MD., Third Department of Internal Medicine, U
nemocnice 1, Prague 2, Czech Republic. E-mail:
tstulc@lf1.cuni.cz
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