Altered Myocardial Vasodilatation in Patients With Hypertriglyceridemia in Anatomically Normal Coronary Arteries

From the Second Department of Internal Medicine (I.Y., S.M., K.Y., N.K., T.A., S.S., M.O.) and the Department of Radiology (T.O., Y.S.), University of Tokyo, Japan.

Abstract—Reduced myocardial vasodilatation (MVD) in hypercholesterolemics without overt coronary stenosis has been reported. However, the status of MVD in hypertriglyceridemics has not yet been clarified. The aim of this study was to investigate whether MVD is impaired in patients with hypertriglyceridemia without overt coronary stenosis. Twenty-three hypertriglyceridemics (10 normocholesterolemic hypertriglyceridemics [HTGs] and 13 mixed combined hyperlipidemics [MCHLs]) and 13 age-matched controls were studied. All patients were proven to have more than one normal coronary artery, as diagnosed by coronary angiography, and those segments that were perfused by anatomically normal coronary arteries were used in the study. Myocardial blood flow (MBF) during dipyridamole (DP) loading and baseline MBF were measured by using positron emission tomography and [¹³N]ammonia, after which MVD was calculated. Baseline MBF (mL · min^-1 · 100 g^-1) was comparable among HTG (76.0±26.1), MCHL (77.0±26.1), and controls (80.3±38.5). However, MBF during DP loading was significantly lower in MCHL (159±52.5) than in control subjects (292±166, P<.01), while it was comparable in HTG (202±104) and controls. MVD was significantly reduced in both HTG (2.70±1.09, P<.05) and MCHL (2.07±.70, P<.01) compared with controls (3.73±1.14). MVD in MCHLs tended to be reduced compared with that in HTGs, but the difference was statistically insignificant (P=.08). There was a significant relationship between MVD and both plasma triglycerides (r=-.47, P<.01) and plasma total cholesterol (r=-.55, P<.01). When controls and HTGs were combined, the relationship between MVD and plasma total triglycerides became more prominent (r=-.55, P<.05), and the significant relationship between cholesterol level and MVD disappeared. Multivariate regression analysis has revealed that the triglyceride level (F=5.2, P<.05) was independently related to MVD (r=.69, P<.01). In conclusion, MVD was reduced in hypertriglyceridemics in anatomically normal coronary arteries. Hypertriglyceridemia is an independent factor for this abnormality.

Key Words: hyperlipidemia • hypertriglyceridemia • atherosclerosis • myocardial vasodilatation • PET

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