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Vuorio A, Kovanen PT, Raal FJ. Coronary microcirculatory dysfunction in hypercholesterolemic patients with COVID-19: potential benefit from cholesterol-lowering treatment. Ann Med 2023; 55:2199218. [PMID: 37068045 PMCID: PMC10116911 DOI: 10.1080/07853890.2023.2199218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
Patients with hypercholesterolemia often have coronary microvascular dysfunction (CMD). Viral infections, such as the SARS-CoV-2 infection, may also result in CMD. Three non-randomized studies have shown significant beneficial effects of statins on CMD in non-infected patients. Similarly, in SARS-CoV-2 - infected patients one beneficial mechanism of action of statins may be the amelioration of endothelial dysfunction, which is a major driver of CMD. Apart from statins, lipoprotein apheresis and PCSK9 inhibitors can also improve or even reverse CMD. The potential reversal of CMD by using effective cholesterol-lowering medications during and after COVID-19 infection, especially in hypercholesterolemic COVID-19 patients, is important.KEY MESSAGESCoronary microvascular dysfunction (CMD) is common in patients hospitalized with SARS-CoV-2 infectionThree nonrandomized studies in non-infected patients are showing the beneficial effects of statin treatment on CMDEffective cholesterol-lowering medication during and after SARS-CoV-2 infection, especially in hypercholesterolemic COVID-19 patients, is of great significance.
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Affiliation(s)
- Alpo Vuorio
- Forensic Medicine, Mehiläinen Airport Health Centre, Vantaa, Finland
- Department of Forensic Medicine, University of Helsinki, Helsinki, Finland
| | - Petri T Kovanen
- Atherosclerosis Research Laboratory, Wihuri Research Institute, Helsinki, Finland
| | - Frederick J Raal
- Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Martino F, Barilla' F, Martino E, Placanica G, Paravati V, Bassareo PP. Nailfold capillaroscopy reveals early peripheral microcirculation abnormalities in children affected by heterozygous familial hypercholesterolemia. Microvasc Res 2023; 148:104545. [PMID: 37146675 DOI: 10.1016/j.mvr.2023.104545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND nailfold capillaroscopy (NCF) is a non-invasive imaging technique to seek peripheral microcirculation abnormalities in children and adults. Familial hypercholesterolemia is a genetic disorder caused by mutations capable of increasing blood levels of low-density lipoproteins cholesterol (LDL-C), thus triggering early atherosclerosis. The study aims at evaluating peripheral microcirculation in children with heterozygous familial hypercholesterolemia (HeFH) by means of NFC in comparison with healthy peers and at searching for possible correlations between these abnormalities and patients' lipid panel. METHODS thirty-six HeFH patients were enrolled (13 males and 23 females. Mean age 8 ± 3 years; age range 3-13 years). They had increased levels of total cholesterol (237.9 ± 34.2 mg/dl) and LDL-C (154.2 ± 37.6 mg/dl). Both values were ≥95th gender and age specific centile. All the subjects in the study underwent NFC. RESULTS In 69.4 % of HeFH children nailfold capillaries were tortuous (p < 0.00001 compared to healthy controls). In 41.6 % the number of capillaries was markedly reduced (<7 capillaries/mm). The mean number of capillaries was 8.4 ± 2.6/mm in HeFH and 12.2 ± 1.4/mm in healthy controls (p < 0.00001). In 100 % of the sample size capillary blood flow was slowed down (p < 0.00001). In 50 % of the sample size a blood "sludge" phenomenon was seen (p < 0.00001). No gender differences were detected. Sludge phenomenon was seen only in those with LDL-C over 99th centile (p < 0.00001). CONCLUSION NCF allows the identification of an early peripheral microvascular dysfunction in HeFH children which is similar to that already seen in atherosclerotic disease. Prompt identification of these capillary abnormalities may be crucial in implementing early prevention measures.
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Affiliation(s)
- Francesco Martino
- Sapienza University of Rome, Department of Internal Medicine, Anaesthesiology, and Cardiovascular Sciences, 00161 Rome, Italy
| | - Francesco Barilla'
- Department of Systems Medicine, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Eliana Martino
- Sapienza University of Rome, Department of Internal Medicine, Anaesthesiology, and Cardiovascular Sciences, 00161 Rome, Italy
| | - Giuseppe Placanica
- Department of Cardiovascular, Nephrological, Anaesthesiological, and Geriatric Sciences, Sapienza University of Rome, 00133 Rome, Italy
| | - Vincenzo Paravati
- Sapienza University of Rome, Department of Internal Medicine, Anaesthesiology, and Cardiovascular Sciences, 00161 Rome, Italy
| | - Pier Paolo Bassareo
- University College of Dublin, School of Medicine, Mater Misericordiae University Hospital and Children's Health Ireland at Crumlin, Dublin, Ireland.
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Assessment of microvascular function and pharmacological regulation in genetically confirmed familial hypercholesterolemia. Microvasc Res 2021; 138:104216. [PMID: 34182004 DOI: 10.1016/j.mvr.2021.104216] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a genetic lipid disorder leading to accelerated atherosclerosis, premature cardiovascular disease and death. Microvascular endothelial dysfunction is one of the earliest vascular pathology manifestations and may precede symptomatic atherosclerosis. METHODS In this paper, microvascular endothelial function was assessed in FH patients and healthy controls using flow mediated skin fluorescence (FMSF), based on measurements of nicotinamide adenine dinucleotide fluorescence intensity during brachial artery occlusion (ischemic response, IR) and immediately after occlusion (hyperemic response, HR). Low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were used to assess its relation with microvascular parameters evaluated in vivo. RESULTS LDL-C levels were significantly correlated to both HRmax (r = -0.548, p = 0.001) and HRindex (r = -0.514, p = 0.003). Similarly, there was a significant inverse correlation of TC levels and both HRmax (r = -0.538, p = 0.002) and HRindex (r = -0.512, p = 0.003). All FMSF parameters were found lower in FH patients compared to age- and sex-matched healthy controls. Hyperemic response (HRmax) was significantly higher in FH patients examined on statins compared to those without any lipid-lowering treatment (19.9 ± 3.1 vs. 16.4 ± 4.2 respectively, p = 0.022). CONCLUSIONS This study shows that, in patients with FH, microvascular endothelial-dependent hyperemic response is impaired and inversely correlated to plasma cholesterol levels. Microvascular function was found better in FH patients receiving statins.
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Vuorio A, Kaste M, Kovanen PT. Familial hypercholesterolemia and statins in the COVID-19 era: Mitigating the risk of ischemic stroke. eNeurologicalSci 2021; 23:100344. [PMID: 33937536 PMCID: PMC8078044 DOI: 10.1016/j.ensci.2021.100344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/18/2021] [Accepted: 04/25/2021] [Indexed: 02/06/2023] Open
Abstract
There is a continuing need for research about the underlying mechanisms behind ischemic strokes in COVID-19 patients. Pre-existing endothelial dysfunction, especially if it is accompanied by a viral infection of the endothelial cells may present an important mechanism behind the immunothrombotic/thromboembolic complications of the COVID-19 illness. Here we emphasize that pharmacotherapy with statins could partly counteract such pathophysiological scenarios. Accordingly, using familial hypercholesterolemia (FH) as a pertinent example of a lifelong endothelial dysfunction, we aim to make the clinicians and consulting neurologists aware of statins as a possible adjuvant therapy in the context of an increased risk of ischemic stroke in patients with COVID-19. Based on recent clinical evidence, there is a need to encourage clinicians and consulting neurologists to continue or initiate effective statin treatment to prevent an ischemic stroke, particularly when they encounter a hypercholesterolemic COVID-19 patient with FH.
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Affiliation(s)
- Alpo Vuorio
- University of Helsinki, Department of Forensic Medicine, 00014 Helsinki, Finland
- Mehiläinen Airport Health Centre, 01530 Vantaa, Finland
| | - Markku Kaste
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Petri T. Kovanen
- Wihuri Research Institute, Biomedicum Helsinki 1, 00290 Helsinki, Finland
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Marcoccia A, Klein-Weigel PF, Gschwandtner ME, Wautrecht JC, Matuska J, Rother U, Houben AJHM. Microcirculatory assessment of vascular diseases. VASA 2020; 49:175-186. [PMID: 32040388 DOI: 10.1024/0301-1526/a000851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The term "microcirculation" refers to the terminal vascular network of the body, which includes arterioles, capillaries, venules as well as initial lymphatic vessels. Additionally, it insinuates to their unique function in thermoregulation, fluid balance, maintenance of cellular exchange, and metabolism. Disturbances of microvascular function were identified to precede macrovascular involvement in the presence of cardiovascular risk factors and is the hallmark of terminal disease stages like critical limb or acral ischemia. Nevertheless, despite its obvious significance in vascular medicine assessment of microvascular function became increasingly neglected in the clinical institutions during the last decades and seems to play a subordinary role in medical education. We therefore provide an overview over relevant and clinically practicable methods to assess microcirculation in vascular medicine with critical estimations of their pros and cons and their perspectives in the future.
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Affiliation(s)
- Antonella Marcoccia
- Unità di Medicina Vascolare e Autoimmunità, CRIIS-Centro di riferimento interdisciplinare per la Sclerosi Sistemica, Rome, Italy
| | - Peter F Klein-Weigel
- Klinik für Angiologie, Zentrum für Innere Medizin II, Ernst von Bergmann Klinikum, Potsdam, Germany
| | - Michael E Gschwandtner
- Medizinische Universtiät Wien, Universitätsklinik für Innere Medizin II, Klinische Abteilung für Angiologie, Vienna, Austria
| | - Jean Claude Wautrecht
- Service de Pathologie Vasculaire, Hôpital ERASME, Université Libre de Bruxelle, Brussels, Belgium
| | - Jiri Matuska
- MATMED s.r.o., Private Angiology Facility, Hodonin, Czech Republic
| | - Ulrich Rother
- Gefäßchirurgische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alfons J H M Houben
- Department of Internal Medicine, School for Cardiovascular Diseases CARIM; Maastricht University Medical Center+, Maastricht, The Netherlands
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Charwat-Resl S, Yarragudi R, Heimbach M, Leitner K, Leutner M, Gamper J, Giurgea GA, Mueller M, Koppensteiner R, Gschwandtner ME, Kautzky-Willer A, Schlager O. Microvascular function in women with former gestational diabetes: A cohort study. Diab Vasc Dis Res 2017; 14:214-220. [PMID: 28111976 DOI: 10.1177/1479164116683148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE In the long term, diabetes mellitus is potentially associated with the occurrence of microvascular damage. This study sought to assess whether a history of prior gestational diabetes mellitus is associated with long-term effects on the women's microcirculation. METHODS Within the scope of a long-term follow-up of the 'Viennese Post-Gestational Diabetes Project', women with prior gestational diabetes mellitus as well as women with previous pregnancy but with no history of gestational diabetes mellitus (controls) were enrolled in this cross-sectional study. Microvascular function was assessed by post-occlusive reactive hyperaemia using laser Doppler fluxmetry. Baseline perfusion, biological zero, peak perfusion, time to peak and recovery time were recorded and compared between both groups. RESULTS Microvascular function was assessed in 55 women with prior gestational diabetes mellitus (46.1 ± 4.6 years) and 32 women with previous pregnancy but without prior gestational diabetes mellitus (42.9 ± 5.3 years). The mean period of time between delivery and the assessment of microvascular function was 16.2 ± 5.2 years in women with prior gestational diabetes mellitus group and 14.2 ± 4.8 years in controls. Regarding microvascular function, baseline perfusion, biological zero, peak perfusion, time to peak and recovery time did not differ between women with prior gestational diabetes mellitus and controls (all p > 0.05). CONCLUSION In the long term, microvascular function appears not to be impaired in women with prior gestational diabetes mellitus.
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Affiliation(s)
- Silvia Charwat-Resl
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
- 2 Cardiology and Intensive Care Medicine, Department of Medicine II, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Rajashri Yarragudi
- 3 Gender Medicine Unit, Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Moritz Heimbach
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Karoline Leitner
- 3 Gender Medicine Unit, Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Michael Leutner
- 3 Gender Medicine Unit, Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Jutta Gamper
- 4 Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Georgiana-Aura Giurgea
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Markus Mueller
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Michael E Gschwandtner
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- 3 Gender Medicine Unit, Division of Endocrinology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Oliver Schlager
- 1 Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
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Narverud I, Retterstøl K, Iversen PO, Halvorsen B, Ueland T, Ulven SM, Ose L, Aukrust P, Veierød MB, Holven KB. Markers of atherosclerotic development in children with familial hypercholesterolemia: A literature review. Atherosclerosis 2014; 235:299-309. [DOI: 10.1016/j.atherosclerosis.2014.05.917] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/04/2014] [Accepted: 05/03/2014] [Indexed: 12/15/2022]
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Schlager O, Giurgea A, Hammer A, Charwat-Resl S, Margeta C, Mueller M, Ehringer T, Zehetmayer S, Willfort-Ehringer A, Koppensteiner R, Gschwandtner ME. Impact of age and gender on microvascular function. Eur J Clin Invest 2014; 44:766-74. [PMID: 24942279 DOI: 10.1111/eci.12293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/13/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Microcirculatory function can be assessed by postocclusive reactive hyperaemia (PORH) using laser Doppler fluxmetry. Previous studies have shown that PORH reveals microvascular damage at an early stage. In particular, at younger ages, PORH might depend on age and gender. To implement PORH into a larger scale of clinical studies, one has to be aware of the influence of age and gender on microcirculation. The aim of this study was to assess the impact of age and gender on microcirculatory function during adolescence. MATERIALS AND METHODS Within the scope of an epidemiological project, 896 children and adolescents underwent assessment of PORH by laser Doppler fluxmetry. Microcirculatory parameters during PORH (baseline perfusion, biological zero, peak perfusion, time to peak perfusion and recovery time) were analysed in relation to age (by tertiles) and gender. RESULTS Baseline perfusion, biological zero and peak perfusion were lower in children/adolescents in the upper age tertile (12·3-18·1 years) than in the middle (9·8-12·2 years) and lower (4·3-9·7 years) age tertiles (P < 0·0001). In the total of participants, baseline perfusion, biological zero and peak perfusion were higher in males than in females (P < 0·0001). Analysing microcirculatory parameters as a function of age and gender, the sex differences were only apparent in the upper and the middle age tertiles, but not in the lower. CONCLUSIONS During adolescence, PORH is a function of age. At higher age, microvascular reactivity considerably depends on gender, whereas no sex differences are present at younger ages.
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Affiliation(s)
- Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
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Huang C, Cen C, Wang C, Zhan H, Ding X. Synergistic effects of colchicine combined with atorvastatin in rats with hyperlipidemia. Lipids Health Dis 2014; 13:67. [PMID: 24742015 PMCID: PMC4005013 DOI: 10.1186/1476-511x-13-67] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/07/2014] [Indexed: 01/20/2023] Open
Abstract
Background Inflammation and endothelial dysfunction is implicated in the atherosclerosis initiation and progression in the setting of hyperlipidemia. Colchicine is a potent anti-inflammatory agent and whether colchicine combined with atorvastatin has synergistic effects on inflammation amelioration and endothelial function improvement is unknown. Methods Hyperlipidemic rat model was produced by high-fat and high-cholesterol diet for 6 weeks. Rats with normal diet were served as shame group. In hyperlipidemic group, normal saline, atorvastatin (10 mg/kg body weight/day), colchicines (0.5 mg/kg body weight/day), or atorvastatin combined with colchicines (same dosages) were prescribed for 2 weeks. Serum levels of lipid profile, C-reactive protein (CRP), liver enzyme, lipoprotein associated phospholipase A2 (Lp-PLA2) and nitric oxide (NO) production were serially assessed. Results Before the beginning of the study, all laboratory variables were comparable among each group. After 6 weeks of hyperlipidemic model production, serum levels of cholesterols, CRP and Lp-PLA2 were significantly increased when compared to sham group, whereas NO production was reduced. With 2 weeks of colchicine therapy, serum levels of CRP and Lp-PLA2 were decreased and NO production was enhanced in the colchicine group in a lipid-lowering independent manner. Added colchicine into atorvastatin therapy further improved NO production and decreased CRP and Lp-PLA2 levels, indicating a potential synergism of colchicine and atorvastatin. Conclusion Colchicine combined with atorvastatin may have stronger protective effects on improving endothelial function and ameliorating inflammation in rats with hyperlipidemia.
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Affiliation(s)
- Congwu Huang
- The Department of Internal Medicine, the Second Affiliated Hospital of Shantou University, Shantou, China.
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