Coronary endothelial dysfunction: from pathogenesis to clinical implications

Humphries, Kenneth M.; Kim, Francis

doi:10.1136/openhrt-2022-002200

Cited by 10 publications

(4 citation statements)

References 50 publications

(94 reference statements)

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“…EPA and DHA modulate some of the most important known risk factors of CAD, such as blood lipids, blood pressure, heart rate, heart rate variability, platelet aggregation, inflammation, and endothelial function [ 6 ]. Of particular interest, endothelial dysfunction is one of the earliest events in the pathological development of atherosclerotic diseases [ 6 , 7 ]. Accordingly, prospective studies have shown that flow-mediated dilation (FMD), the gold standard for measuring endothelial dysfunction in vivo, is an independent predictor of cardiovascular events, such as heart attack or stroke [ 6 , 7 , 8 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Of particular interest, endothelial dysfunction is one of the earliest events in the pathological development of atherosclerotic diseases [ 6 , 7 ]. Accordingly, prospective studies have shown that flow-mediated dilation (FMD), the gold standard for measuring endothelial dysfunction in vivo, is an independent predictor of cardiovascular events, such as heart attack or stroke [ 6 , 7 , 8 , 9 , 10 , 11 ]. Therefore, therapies targeted to improve endothelial dysfunction, such as EPA and DHA supplementation, may report important benefits to subjects at risk of CAD.…”

Section: Introductionmentioning

confidence: 99%

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Eicosapentaenoic and Docosahexaenoic Acid Supplementation Increases HDL Content in n-3 Fatty Acids and Improves Endothelial Function in Hypertriglyceridemic Patients

Peña-de-la-Sancha

Muñoz-García

Espínola‐Zavaleta

et al. 2023

IJMS

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High-density lipoproteins (HDLs) are known to enhance vascular function through different mechanisms, including the delivery of functional lipids to endothelial cells. Therefore, we hypothesized that omega-3 (n-3) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) content of HDLs would improve the beneficial vascular effects of these lipoproteins. To explore this hypothesis, we performed a placebo-controlled crossover clinical trial in 18 hypertriglyceridemic patients without clinical symptoms of coronary heart disease who received highly purified EPA 460 mg and DHA 380 mg, twice a day for 5 weeks or placebo. After 5 weeks of treatment, patients followed a 4-week washout period before crossover. HDLs were isolated using sequential ultracentrifugation for characterization and determination of fatty acid content. Our results showed that n-3 supplementation induced a significant decrease in body mass index, waist circumference as well as triglycerides and HDL-triglyceride plasma concentrations, whilst HDL-cholesterol and HDL-phospholipids significantly increased. On the other hand, HDL, EPA, and DHA content increased by 131% and 62%, respectively, whereas 3 omega-6 fatty acids significantly decreased in HDL structures. In addition, the EPA-to-arachidonic acid (AA) ratio increased more than twice within HDLs suggesting an improvement in their anti-inflammatory properties. All HDL-fatty acid modifications did not affect the size distribution or the stability of these lipoproteins and were concomitant with a significant increase in endothelial function assessed using a flow-mediated dilatation test (FMD) after n-3 supplementation. However, endothelial function was not improved in vitro using a model of rat aortic rings co-incubated with HDLs before or after treatment with n-3. These results suggest a beneficial effect of n-3 on endothelial function through a mechanism independent of HDL composition. In conclusion, we demonstrated that EPA and DHA supplementation for 5 weeks improved vascular function in hypertriglyceridemic patients, and induced enrichment of HDLs with EPA and DHA to the detriment of some n-6 fatty acids. The significant increase in the EPA-to-AA ratio in HDLs is indicative of a more anti-inflammatory profile of these lipoproteins.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Eicosapentaenoic and Docosahexaenoic Acid Supplementation Increases HDL Content in n-3 Fatty Acids and Improves Endothelial Function in Hypertriglyceridemic Patients

Peña-de-la-Sancha

Muñoz-García

Espínola‐Zavaleta

et al. 2023

IJMS

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“…Прогресування ІХС і розвиток стенокардії високих ФК супроводжується дисбалансом у системі вазодилатуючих і вазоконстрикторних ендотеліальних чинників, які визначають тонус гладком'язових клітин судин і відіграють важливу роль у формуванні її клінічного перебігу [5, 21,22].…”

Section: результати дослідження та їх обговоренняunclassified

Clinical, Metabolic and Neurohumoral Effects of L-arginine in Patients with Coronary Heart Disease in Combination with Arterial Hypertension

Kochuiev,

Hrek,

Kochuieva

2024

FMEP

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The objective: to analyze the impact of complex therapy using L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid on the functional state of the endothelium, tolerance to physical activity, indicators of oxidative stress, lipid metabolism and clinical status patients with stable angina pectoris of the III functional class (FC) in comorbidity with arterial hypertension (AH) of the II grade, stage 2. Materials and methods. 100 patients with stable angina pectoris III FC and AH II grade, stage 2 aged 55–68 years participated in the study. The patients were divided into two groups: 50 patients of the 1st group received standard therapy – RAAS blocker, amlodipine, bisoprolol, acetylsalicylic acid and atorvastatin; 50 patients of the 2nd group in addition to standard therapy received a multi-component product of complex action, which includes L-arginine, ubiquinone (coenzyme Q10), Lcarnitine, lycopene, a number of plant extracts and folic acid, in a dose of 1 sachet per day. At the beginning and at the end of the study endothelial functions were assessed, daily blood pressure (BP) was monitored, physical exercise testing was performed, the weekly number of angina attacks and nitroglycerin tablet taking were recorded, oxidative status parameters were studied, quality of life was assessed, and the results were statistically processed. Results. The use of complex action preparation, which includes L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid, as adjuvant therapy demonstrated a decrease in the level of indicators of lipid peroxidation (LPO) and an increase levels of antioxidant protection parameters. In the patients of the 2nd group a statistically significant positive dynamics of the blood pressure level was found: the median of daily systolic blood pressure (SBP) decreased to 131.78 mm (p<0.01). A significant decrease in median daytime and nighttime SBP and diastolic blood pressure (DBP) was also determined (p<0.01). The use of a multicomponent preparation of complex action led to a significant decreased of total cholesterol (CHL) by 14.5%, TG by 10.37% and low-density lipoprotein cholesterol by 12.5%. There was also an increased level of high-density lipoprotein cholesterol by 6.48% (р<0.05 for all indicators). The patients of the 2nd group demonstrated a significant increase in tolerance to physical excesses: an increase in the double product by 21.4% and the total amount of the done work by 78.4% compared to the initial values (р<0.05 for both indicators). After 2 months of treatment the difference between the groups in terms of the decrease in the weekly number of angina attacks was statistically significant (р<0.05). This positive trend was accompanied by a decrease in the median number of nitroglycerin tablets taken per week in the 2nd group from 5.4 to 3.0 (р<0.05). In the patients of the 2nd group after 2 months of observation a statistically significant improvement in quality of life indicators according to the “Seattle Angina Questionnaire” was determined (р<0.05). Conclusions. Although all study participants received identical standard antihypertensive and lipid-lowering therapy, adjuvant use of a multicomponent complex of L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts, and folic acid for 2 months demonstrated a reduction in the impact of oxidative stress with parallel restoration of antioxidant mechanisms, improvement in vascular reactivity in patients and daily control of blood pressure, contributed to the correction of the lipid profile with increased tolerance to physical exercise and, as a result of the above-mentioned effects, had a significant positive impact on the quality of life of patients.

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“…This score is based on parameters that reflect the patient's nutritional and inflammatory status and is based on total cholesterol, albumin, lymphocyteto-monocyte ratio (LMR), and neutrophil-lymphocyte ratio (NLR) [1,2]. Many studies have shown that low albumin, high cholesterol, and chronic inflammation are related to an increased risk of coronary slow flow phenomenon (CSFP) as early stage of coronary artery disease [3][4][5]. The combination of these risk factors corresponds to the NPS parameters except the cholesterol level.…”

Section: Introductionmentioning

confidence: 99%

Modified naples prognostic score as a potential predictor for coronary slow flow: a retrospective observational study

Oguz,

Dogan,

Babaoglu

et al. 2023

Med-Science

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The Naples prognostic score (NPS) predicts patient survival in gastroesophageal cancer using parameters related to nutritional and inflammatory status. These parameters include risk factors for coronary endothelial dysfunction except for low total cholesterol. Therefore, we modified the score (mNPS) to include high cholesterol, a risk factor for coronary endothelial dysfunction. We aimed to evaluate the relationship between mNPS and the angiographic epicardial coronary slow flow phenomenon (CSFP). This retrospective study included 301 patients with coronary slow flow who underwent coronary angiography between 2018 and 2022. The mNPS parameters were calculated and the population was divided into three groups based on the calculated parameters. Angiographic findings were classified in the left anterior descending (LAD), circumflex (Cx), right coronary (RCA) arteries, and three coronary arteries together. Statistical analyses were performed to identify mNPS as predictors of a slow flow phenomenon. Participants were divided into mNPS Group 1 (n=63), mNPS Group 2 (n=201), and mNPS Group 3 (n=37). No significant differences were observed in age, gender, or medications among the mNPS groups. The RCA had a statistically significant association with mNPS groups for slow flow phenomenon (p=0.006). Considering all three coronary arteries, the association with mNPS groups was also significant (p=0.005). White blood cell and lymphocyte counts showed significant differences. Compared with group 1, group 3 had 4.11 times more coronary artery slow flow. Our study suggests that the mNPS, integrating nutritional and inflammatory parameters along with high cholesterol, holds promise as a potential predictor for the coronary slow flow phenomenon. This could impact risk stratification and clinical management in this patient group.

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Coronary endothelial dysfunction: from pathogenesis to clinical implications

Cited by 10 publications

References 50 publications

Eicosapentaenoic and Docosahexaenoic Acid Supplementation Increases HDL Content in n-3 Fatty Acids and Improves Endothelial Function in Hypertriglyceridemic Patients

Eicosapentaenoic and Docosahexaenoic Acid Supplementation Increases HDL Content in n-3 Fatty Acids and Improves Endothelial Function in Hypertriglyceridemic Patients

Clinical, Metabolic and Neurohumoral Effects of L-arginine in Patients with Coronary Heart Disease in Combination with Arterial Hypertension

Modified naples prognostic score as a potential predictor for coronary slow flow: a retrospective observational study

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