Coronary Microvascular Endothelial Dysfunction in Patients With Angina and Nonobstructive Coronary Artery Disease Is Associated With Elevated Serum Homocysteine Levels.
Coronary Microvascular Endothelial Dysfunction in Patients With Angina and Nonobstructive Coronary Artery Disease Is Associated With Elevated Serum Homocysteine Levels.
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DOI：
10.1161/jaha.120.017746
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发表时间：
2020-10-20
影响因子：
5.4
通讯作者：
Lerman A
中科院分区：
文献类型：
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作者：
Ahmad A;Corban MT;Toya T;Sara JD;Lerman B;Park JY;Lerman LO;Lerman A
由于一氧化氮生成受损而导致的血清同型半胱氨酸水平升高以及冠状动脉微血管功能障碍与主要不良心血管事件的风险增加相关。然而，血清同型半胱氨酸水平与冠状动脉微血管内皮功能障碍（CMED）是否相关仍不清楚。这项研究纳入了 1418 名患有胸痛或功能压力测试异常以及患有非阻塞性冠状动脉疾病（<40% 血管造影狭窄）的患者，他们接受了功能性血管造影的 CMED 评估，并测量了血清同型半胱氨酸水平。患者被分为具有正常微血管功能与 CMED 的患者。 CMED 组患者 (n=743；52%) 的平均年龄较高（52.1±12.2 岁 vs 50.0±12.4 岁；P<0.0001），体重指数较高（29.1 [25.0–32.8] vs 27.5 [24.2–32.4]；P=0.001），患有糖尿病（12.5% vs 12.5%） 9.4%），并且 与微血管功能正常组的患者相比，女性患者较少（63.5% vs 68.7%；P=0.04）。然而，他们的吸烟史比例较低，低密度脂蛋白胆固醇水平也略有较低。 CMED 患者的血清同型半胱氨酸水平显着较高，调整年龄后，血清同型半胱氨酸水平的最高四分位数 (>9 µmol/L) 是 CMED 的独立预测因子（比值比，1.34 [95% CI，1.03–1.75]；P=0.03）；性别;体重指数；慢性肾病（CKD）；糖尿病；吸烟暴露；低密度脂蛋白胆固醇；高密度脂蛋白胆固醇和甘油三酯；以及阿司匹林、他汀类药物和 B 族维生素的使用。 CMED 患者的血清同型半胱氨酸水平显着升高。血清同型半胱氨酸水平升高与 CMED 侵入性诊断的几率显着增加相关。目前的研究支持同型半胱氨酸在早期冠状动脉粥样硬化患者的诊断和靶向治疗中的潜在作用。
Elevated levels of serum homocysteine, via impaired nitric oxide production, and coronary microvascular dysfunction are associated with increased risk of major adverse cardiovascular events. However, whether serum homocysteine levels and coronary microvascular endothelial dysfunction (CMED) are linked remains unknown. This study included 1418 patients with chest pain or an abnormal functional stress test and with nonobstructive coronary artery disease (<40% angiographic stenosis), who underwent CMED evaluation with functional angiography and had serum homocysteine levels measured. Patients were classified as having normal microvascular function versus CMED. Patients in the CMED group (n=743; 52%) had higher mean age (52.1±12.2 versus 50.0±12.4 years; P<0.0001), higher body mass index (29.1 [25.0–32.8] versus 27.5 [24.2–32.4]; P=0.001), diabetes mellitus (12.5% versus 9.4%; P=0.03), and fewer women (63.5% versus 68.7%; P=0.04) compared with patients in the normal microvascular function group. However, they had lower rates of smoking history, and mildly lower low‐density lipoprotein cholesterol levels. Serum homocysteine levels were significantly higher in patients with CMED, and the highest quartile of serum homocysteine level (>9 µmol/L) was an independent predictor of CMED (odds ratio, 1.34 [95% CI, 1.03–1.75]; P=0.03) after adjustment for age; sex; body mass index; chronic kidney disease (CKD); diabetes mellitus; smoking exposure; low‐density lipoprotein cholesterol; high‐density lipoprotein cholesterol and triglycerides; and aspirin, statin, and B vitamin use. Patients with CMED have significantly higher levels of serum homocysteine. Elevated serum homocysteine levels were associated with a significantly increased odds of an invasive diagnosis of CMED. The current study supports a potential role for homocysteine for diagnosis and target treatment in the patients with early coronary atherosclerosis.