The cardiovascular phenotype of adult patients with phenylketonuria

Abstract

Background: Patients with Phenylketonuria (PKU) are exposed to multiple cardiovascular risk factors, but the clinical significance of these abnormalities is yet unknown. The purpose of this study was to characterize the cardiovascular phenotype in adult patients with PKU by clinical and dietary data, measurements of biochemical markers, and non-invasive examination of vascular functions.

Results: Twenty-three adult patients with PKU (age: 18-47 y; 30.8 ± 8.4 y) and 28 healthy controls (age: 18-47 y; 30.1 ± 9.1 y) were included in this study. PKU patients had significantly higher systolic and diastolic blood pressure, increased resting heart rate and a higher body mass index. Total cholesterol and non-HDL cholesterol levels were significantly increased in PKU patients, whereas plasma levels of HDL cholesterol and its subfraction HDL2 (but not HDL3) were significantly decreased. The inflammatory markers C-reactive protein and serum amyloid A protein and the serum oxidative stress marker malondialdehyde were significantly higher in patients with PKU. Venous occlusion plethysmography showed marked reduction in post-ischemic blood flow and the carotid to femoral pulse wave velocity was significantly increased demonstrating endothelial dysfunction and increased vascular stiffness.

Conclusions: This study shows that the cardiovascular phenotype of adult PKU patients is characterized by an accumulation of traditional cardiovascular risk factors, high levels of inflammatory and oxidative stress markers, endothelial dysfunction and vascular stiffness. These data indicate the need for early cardiovascular risk reduction in patients with PKU.

Keywords: Cardiovascular risk factors; Endothelial dysfunction; Oxidative stress; Phenylketonuria; Vascular stiffness.

Fig. 1

a Serum lipoprotein lipids in patients with phenylketonuria (PKU) and healthy controls. Bar charts showing the mean and SD. *p < 0.05, **p ≤ 0.01, ***p ≤ 0.001 (Unpaired T-Test). b Box-plot presentation of SAA, CRP and MDA serum levels in patients with phenylketonuria (PKU) and healthy controls. *p < 0.05, **p ≤ 0.01 (Mann-Whitney-U-Test)

Fig. 2

Post-ischemic flow reserve (PIFR) and pulse wave velocity (PWV) in patients with phenylketonuria (PKU) and healthy controls. Bar charts showing the mean and SD. **p ≤ 0.01, ***p ≤ 0.001 (Unpaired t-test)