Relationship between vascular dysfunction in peripheral arteries and ischemic episodes during daily life in patients with ischemic heart disease and hypercholesterolemia

Background It is well established that endothelial dysfunction is present in patients with ischemic heart disease and hypercholesterolemia. Some of these patients will have signs of transient myocardial ischemia during Holter monitoring. We sought to describe the correlation between daily life ischemia and signs of endothelial dysfunction as assessed by means of brachial vasoreactivity. Methods We included in the study 131 patients with documented ischemic heart disease and a serum cholesterol level of ≥5 mmol/L before the institution of lipid-lowering treatment and dietary intervention. Results Satisfactory 48-hour Holter recordings and ultrasound scans of the brachial artery were obtained in 119 patients. During 5712 hours of ambulatory monitoring, 181 episodes of transient ST-segment depression with a mean duration of 52 ± 66 minutes were recorded in 31 patients. The mean percentage dilatation of the brachial artery after occlusion was 4.38% ± 5.66%; after nitroglycerin administration, it was 13.86% ± 7.06%. By means of Spearman correlation analysis, the number of ischemic episodes and degree of flow-mediated vasodilatation and nitroglycerin-mediated vasodilatation were significantly negatively correlated (r = −0.249, P = .006 and r = −0.302, P = .02, respectively). In a linear regression model, the presence of ischemic episodes was a significant predictor of impaired flow-mediated vasodilatation (β = −3.31, P < .01), even after the adjustment for vessel size and classic cardiovascular risk factors. Conclusions These results indicate a significant relationship between ischemic episodes and vascular dysfunction in patients with ischemic heart disease and hypercholesterolemia and may justify an aggressive preventive therapy targeted directly at the endothelium. (Am Heart J 2002;144:108-14.)