Hyperlipidaemia, hypertension, and coronary heart disease

Goode, Grahame K.; Miller, John P.; Heagerty, AM

doi:10.1016/s0140-6736(95)90345-3

Cited by 136 publications

(93 citation statements)

References 42 publications

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“…The dissociation of hypertension from this endothelial dysfunction must point to another parameter in the metabolic syndrome of diabetes being responsible. In this article, we report significant correlations between maximum Ach-induced dilation and total cholesterol in all our subject groups, a finding previously documented in hyperlipidemic patients, 3,11 and in subjects with high-normal lipid profiles. 12 In this context, it has been shown that hypercholesterolemia reduces the bioavailability of nitric oxide: Potential mechanisms include reduced availability of L-arginine, downregulation of the guanosine Gi␣ subunit that mediates nitric oxide activation, reduced expression of nitric oxide synthase, and inactivation of nitric oxide by superoxide anions or oxidized lipoproteins.…”

Section: Discussionsupporting

confidence: 83%

Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus

et al. 2002

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Background-To further investigate vascular morphology and function in type 2 (non-insulin-dependent) diabetes mellitus (type 2D), small arteries were examined in vitro from carefully defined cohorts of patients with or without concomitant hypertension and the results compared with those from selected normotensive nondiabetic control subjects and a group of untreated patients with essential hypertension (EH). Methods and Results-Blood vessels were studied through the use of pressure myography to determine vascular morphology, mechanics, and myogenic responsiveness, together with testing of constrictor and dilator function. Small arteries from patients with EH demonstrated eutrophic inward remodeling and an increased distensibility. Vessels from type 2D patients demonstrated hypertrophy, a further increase in distensibility, and a highly significant loss of myogenic responsiveness compared with patients with EH and control patients. Vasoconstrictor function to norepinephrine was normal in patients with type 2D and type 2DϩH and EH. Endothelium-dependent dilation was normal in patients with EH but abnormal in patients with type 2D and type 2DϩH. There was a significant correlation between dilator impairment and the degree of dyslipidemia recorded in all groups. Conclusions-These results demonstrate vascular hypertrophy in small arteries from patients with type 2D. This could be a consequence of impaired myogenic responsiveness, which will increase wall stress for a given intraluminal pressure, which may be a stimulus for vascular hypertrophy. A substantial proportion of endothelial dysfunction can be attributed to an effect of the abnormal lipid profile seen in such patients. (Circulation. 2002;106:3037-3043.)

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Section: Discussionsupporting

confidence: 83%

Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus

et al. 2002

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“…4 Reviewing recent lipid-lowering trials, Goode et al 5 have provided evidence for an association between plasma concentrations of cholesterol and resting blood pressure. The association, however, is relatively weak, and cholesterollowering therapy results in only a modest reduction in blood pressure.…”

mentioning

confidence: 99%

“…The association, however, is relatively weak, and cholesterollowering therapy results in only a modest reduction in blood pressure. 5 Hypercholesterolemia may influence vascular reactivity to a greater degree than basal tone. [1][2][3] Such an effect might influence blood pressure during exercise more strongly than blood pressure at rest.…”

mentioning

confidence: 99%

Diastolic Blood Pressure Changes During Exercise Positively Correlate With Serum Cholesterol and Insulin Resistance

2000

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Background-Metabolic factors, including plasma concentrations of cholesterol and insulin resistance, may influence blood pressure through effects on vascular reactivity. Such effects might influence blood pressure during exercise more strongly than at rest. Methods and Results-We examined whether there is an association between serum cholesterol or insulin resistance and change in blood pressure during mild exercise. Blood pressure was measured at rest and during fixed low-workload bicycle ergometry (50, 75, and 100 W, each for 3 minutes) in 75 healthy active men (age, 18 to 66 years). Blood pressure at rest was not significantly correlated with serum cholesterol or insulin resistance (estimated from the fasting glucose-insulin product). The change from resting values in diastolic but not systolic blood pressure during exercise was correlated with serum cholesterol (RϾ0.47, PϽ0.0001 for each workload) and insulin resistance (RϾ0.38, PϽ0.01 for each workload). Serum cholesterol and insulin resistance were the only independent predictors of the change in diastolic blood pressure during exercise in a stepwise regression model incorporating age, body mass index, serum cholesterol, triglycerides, HDL cholesterol, insulin resistance, and heart rate during exercise. In a further study, the change in diastolic blood pressure during exercise was greater in men with uncomplicated type 2 diabetes (13.

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“…5,6 In epidemiological studies, where hypertension has been linked to hyperlipidaemia, the principal factors seem to be insulin resistance and saturated fat intake (ie plasma cholesterol) ( Table 1). 7 Endothelial dysfunction has been described in association with hypertension in many studies; it also has strong associations with insulin resistance, dyslipidaemia, and other cardiovascular risk factors. 8 Indeed, hypertension and hypercholesterolaemia act synergistically as cardiovascular risk factors, although the exact mechanisms are obscure but certainly include both insulin resistance and endothelial dysfunction.…”

Section: Epidemiologymentioning

confidence: 99%

Lipid lowering: another method of reducing blood pressure?

Wierzbicki

2002

J Hum Hypertens

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Modern management of cardiovascular risk depends on assessment of cardiovascular risk factors. Hypertension and hyperlipidaemia are synergistic risk factors for cardiovascular events. Both show a degree of crosscorrelation through sharing mechanisms of pathogenesis including insulin resistance and endothelial dysfunction. This article reviews the common pathways leading to dyslipidaemia and hypertension and the effects diet and lipid-lowering drug therapies have had on correcting blood pressure in patients with essential hypertension. Both statins and fibrates have shown a capability to lower blood pressure by up to 8/5 and 15/ 10 mmHg respectively, in some small-scale clinical trials and have effects on arterial wall structure and hence pulse wave velocity. This blood pressure action may account for some of the clinical effects of lipid-lowering drugs on cardiovascular risk. Thus, lipid lowering may provide an additional method of correcting hypertension in some high-risk patients. However, data from largescale intervention trials are either absent or ambiguous. Definitive large-scale trials to investigate the antihypertensive effects of lipid-lowering drugs are required, although end point studies examining the interaction of lipid-lowering and antihypertensive drugs to determine optimum combinations are already under way.

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Hyperlipidaemia, hypertension, and coronary heart disease

Cited by 136 publications

References 42 publications

Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus

Vascular Structural and Functional Changes in Type 2 Diabetes Mellitus

Diastolic Blood Pressure Changes During Exercise Positively Correlate With Serum Cholesterol and Insulin Resistance

Lipid lowering: another method of reducing blood pressure?

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