Beyond Blood Pressure

Obes Rev. 2019 Mar 18. doi: 10.1111/obr.12831. [Epub ahead of print] The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta-analysis. Loader J1,2,3, Khouri C4,5, Taylor F2, Stewart S6, Lorenzen C7, Cracowski JL4,5, Walther G3,7, Roustit M4,5. Author information 1 Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia.2 Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.3 LAPEC EA4278, Avignon Université, Avignon, France.4 Inserm U1042, Université Grenoble Alpes, Grenoble, France.5 Clinical Pharmacology, Grenoble Alpes University Hospital, Grenoble, France.6 Hatter Institute for Reducing Cardiovascular Disease in Africa, The University of Cape Town, Cape Town, South Africa.7 School of Exercise Science, Australian Catholic University, Melbourne, Australia. Abstract This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (-0.41%, 95% CI, -0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (-4.26%, 95% CI, -4.97 to -3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes. © 2019 World Obesity Federation. KEYWORDS: endothelial dysfunction; insulin resistance; obesity; vascular function PMID:30887713

Open Heart. 2019 Feb 2;6(1):e000870. doi: 10.1136/openhrt-2018-000870. eCollection 2019.

Coronary endothelial function testing may improve long-term quality of life in subjects with microvascular coronary endothelial dysfunction.

Reriani M1,2, Flammer AJ1, Duhé J1, Li J1, Gulati R1, Rihal CS1, Lennon R3, Tilford JM1, Prasad A1, Lerman LO4, Lerman A1.

Author information 1 Division of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.2 Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.3 Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.4 Division of Nephrology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Abstract AIM: Angina pectoris in the absence of obstructive coronary artery disease (CAD) is common and is associated with poor quality of life (QOL). Coronary microvascular endothelial dysfunction is associated with myocardial ischaemia and is a common cause of angina. We hypothesise that evaluation of coronary endothelial function, its diagnosis and treatment will favourably impact QOL in patients with angina symptoms and non-obstructive CAD. METHODS AND RESULTS: Follow-up was done on 457 patients with chest pain and non-obstructive coronary arteries who had undergone coronary vascular reactivity evaluation by administration of intracoronary acetylcholine at the time of diagnostic study. After a mean follow-up of 8.4±4.7 years, QOL was assessed by administration of the SF-36 QOL survey. Patients diagnosed and treated for microvascular endothelial dysfunction had a higher (better) overall mental composite score (44.8 vs 40.9, p=0.036) and mental health score (44.2 vs 40.7, p=0.047), and a trend towards higher vitality scores (39.1 vs 35.9, p=0.053) and role emotional scores (43.6 vs 40.4, p=0.073), compared with patients with normal endothelial function. CONCLUSION: Among patients with chest pain and normal coronaries, diagnosis and treatment of coronary microvascular endothelial dysfunction in those with angina pectoris and non-obstructive CAD are associated with better QOL compared with patients with normal endothelial function.

KEYWORDS: angina; microvascular endothelial function; quality of life Full-text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361373/