Predictors of endothelial function improvement in patients with mild hypertriglyceridemia without evidence of coronary artery disease treated with purified eicosapentaenoic acid
Predictors of endothelial function improvement in patients with mild hypertriglyceridemia without evidence of coronary artery disease treated with purified eicosapentaenoic acid
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DOI：
10.1016/j.atherosclerosis.2020.07.013
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发表时间：
2020-09-01
期刊：
影响因子：
5.3
通讯作者：
Shuto, Taichi
中科院分区：
文献类型：
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作者：
Fukumoto, Kazuo;Takemoto, Yasuhiko;Shuto, Taichi
背景和目的：二十碳五烯酸(EPA)已被报道可降低高甘油三酯血症患者的心血管风险。尽管EPA的作用机制已被证实，但对无冠状动脉疾病(CAD)证据的高甘油三酯血症患者的作用机制尚未完全阐明。我们试图阐明与EPA应用相关的导致内皮功能改善的主要因素。方法：47名无冠心病证据的轻度高甘油三酯血症患者(平均年龄59+/-13岁)前瞻性入选并接受纯化EPA(1800 mg/d)治疗。44名没有服用EPA的患者被登记为年龄和性别匹配的对照组。在治疗前和治疗6个月后检查临床变量和血流介导的扩张(FMD)。结果：EPA治疗可降低甘油三酯水平(从224.6+/-58.8mgdl降至151.8+/-54.5mgdl，p<；0.001)，增加FMD(从4.21%+/-1.91%至6.21%+/-2.30%，p<；0.001)。多因素分析显示，FMD的变化与基础高密度脂蛋白胆固醇水平(β=-0.331，p=0.027)和环磷酰胺/花生四烯酸(AA)比值的变化(β=0.301，p=0.048)有关。结论：EPA治疗改善了轻度高甘油三酯血症患者的甘油三酯水平和FMD。基线高密度脂蛋白胆固醇水平和EPA/AA比值的变化预示FMD的改善。EPA对富含甘油三酯的脂蛋白和血管内皮细胞的有益作用可能有助于改善内皮功能。
Background and aims: Eicosapentaenoic acid (EPA) has been reported to reduce cardiovascular risk in patients with hypertriglyceridemia. Although several mechanisms underlying the effects of EPA have been demonstrated, those responsible for its beneficial role in patients with hypertriglyceridemia without evidence of coronary artery disease (CAD) have not been fully elucidated. We sought to clarify the main factors associated with EPA administration that led to improved endothelial function.Methods: Forty-seven consecutive patients with mild hypertriglyceridemia (mean age, 59 +/- 13 years) without evidence of CAD were prospectively enrolled and administered purified EPA (1800 mg/day). Forty-four patients who were not administered EPA were enrolled as age- and sex-matched controls. Clinical variables and flow-mediated dilation (FMD) were examined before and after 6 months of treatment. Univariate and multivariate regression analyses were performed between FMD changes and clinical variables.Results: EPA treatment decreased triglyceride levels (from 224.6 +/- 58.8 to 151.8 +/- 54.5 mg/dl, p < 0.001) and increased FMD (from 4.21% +/- 1.91% to 6.21% +/- 2.30%, p < 0.001). Multivariate analysis showed that the change in FMD was associated with the baseline high-density lipoprotein cholesterol (HDL-C) level (beta = - 0.331, p = 0.027) and the change in EPA/arachidonic acid (AA) ratio (beta = 0.301, p = 0.048).Conclusions: EPA treatment improved triglyceride levels and FMD in patients with mild hypertriglyceridemia and without evidence of CAD. The baseline HDL-C level and the change in EPA/AA ratio predicted FMD improvement. The beneficial effects of EPA on triglyceride-rich lipoproteins and vascular endothelium may help improve endothelial function.