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Multicenter Study
. 2017 Sep 14;6(9):e006082.
doi: 10.1161/JAHA.117.006082.

Body Mass Index Is Associated With Microvascular Endothelial Dysfunction in Patients With Treated Metabolic Risk Factors and Suspected Coronary Artery Disease

Dirk J van der Heijden  1 , Maarten A H van Leeuwen  2 , Gladys N Janssens  2 , Mattie J Lenzen  3 , Peter M van de Ven  4 , Etto C Eringa  5 , Niels van Royen  6
Affiliations
Multicenter Study

Body Mass Index Is Associated With Microvascular Endothelial Dysfunction in Patients With Treated Metabolic Risk Factors and Suspected Coronary Artery Disease

Dirk J van der Heijden et al. J Am Heart Assoc. .

Abstract

Background: Obesity is key feature of the metabolic syndrome and is associated with high cardiovascular morbidity and mortality. Obesity is associated with macrovascular endothelial dysfunction, a determinant of outcome in patients with coronary artery disease. Here, we compared the influence of obesity on microvascular endothelial function to that of established cardiovascular risk factors such as diabetes mellitus, hypertension, hypercholesterolemia, and smoking in patients with suspected coronary artery disease.

Methods and results: Endothelial function was assessed during postocclusive reactive hyperemia of the brachial artery and downstream microvascular beds in 108 patients who were scheduled for coronary angiography. In all patients, microvascular vasodilation was assessed using peripheral arterial tonometry; laser Doppler flowmetry and digital thermal monitoring were performed. Body mass index was significantly associated with decreased endothelium-dependent vasodilatation measured with peripheral arterial tonometry (r=0.23, P=0.02), laser Doppler flowmetry (r=0.30, P<0.01), and digital thermal monitoring (r=0.30, P<0.01). In contrast, hypertension, hypercholesterolemia, and smoking had no influence on microvascular vasodilatation. Especially in diabetic patients, endothelial function was not significantly reduced (control versus diabetes mellitus, mean±SEM or median [interquartile range], peripheral arterial tonometry: 1.90±0.20 versus 1.67±0.20, P=0.19, laser Doppler flowmetry: 728% [interquartile range, 427-1110] versus 589% [interquartile range, 320-1067] P=0.28, and digital thermal monitoring: 6.6±1.0% versus 2.5±1.7%, P=0.08). In multivariate linear regression analysis, body mass index was the only risk factor that significantly attenuated endothelium-dependent vasodilatation using all 3 microvascular function tests.

Conclusions: Higher body mass index is associated with reduced endothelial function in patients with suspected coronary artery disease, even after adjustment for treated diabetes mellitus, hypertension, hypercholesterolemia, and smoking.

Keywords: body mass index; digital thermal monitoring; endothelial function; laser Doppler flowmetry; microcirculation; peripheral arterial tonometry.

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Figures

Figure 1
Figure 1
Scatter plots of correlation BMI and RHI, flux change (LDF), and temperature change (DTM). BMI indicates body mass index; DTM, digital thermal monitoring; LDF, laser Doppler flowmetry; RHI, Reactive Hyperemic Index.
Figure 2
Figure 2
Examples of microvascular endothelial test in a patient with high and low BMI: (A) representing a patient with a high BMI (34.9 kg/m2) and (B) representing a patient with a low BMI (20.6 kg/m2). The red dotted line indicates time of occlusion, the green dotted line hyperemia. Upper to lower panel: thermography (Ther) of the thumb followed by DTM, LDF, and PAT curves. BMI indicates body mass index; DTM, digital thermal monitoring; LDF, laser Doppler flowmetry; PAT, peripheral arterial tonometry.
See this image and copyright information in PMC

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