Endothelial dysfunction and cardiovascular risk profile in long-term withdrawing alcoholics
Endothelial dysfunction and cardiovascular risk profile in long-term withdrawing alcoholics
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DOI：
10.1097/hjh.0b013e328010929c
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发表时间：
2007-02-01
影响因子：
4.9
通讯作者：
Montanari, Alberto
中科院分区：
文献类型：
--
作者：
Di Gennaro, Cristiana;Biggi, Almerina;Montanari, Alberto
研究背景重度酗酒者的心血管发病率和死亡率高于戒酒者和轻中度饮酒者。目的在假设导致动脉粥样硬化损害的因素即使在长期戒酒后仍然有效的假设下，我们研究了既往重度酗酒者心血管风险增加的可能机制。方法42名明显无病、血压正常的戒酒者参与研究，戒毒时间为37.1+/-31.9个月(SD)，中位数为24。他们与39名终生戒酒的对照组受试者进行了比较，这些受试者在年龄、性别、体重指数、吸烟和饮食习惯、体育活动、血脂和空腹血糖方面进行了仔细的匹配。结果戒酒后血压显著升高(收缩压127.5±12.9vs.118.2+/-10.7 mm Hg，P<；0.001)，血管内皮细胞活化、氧化应激、血管炎症和胰岛素敏感性的最大百分比明显降低(10.1+/-4.6vs14.9+/-7.4vs14.9+/-7.4vs14.9+/-7.4vs14.9+/-7.4vs14.9+/-7.4vs14.9+/-7.4vs14.9+/-7.4vs14.9+/-7.4mmHg，P<；0.001；舒张压为79.4+/-7.1vs74.6+/-6.4毫米汞柱，P<；0.001；平均95.4+/-8.2vs89.1+/-7.3mgHg，尿酸(5.0+/-1.1vs4.4+/-0.8mgdl，P<；0.05)，高敏C反应蛋白(2.1vs1.0+/-0.9 mg/L，P<；内皮素-1(0.001-38+/-0.11vs0.17+/-0.10pg/ml，P<；0.001)和空腹胰岛素(10.4+/-4.5vs5.6+/-1.6mU/ml，P<；0.001)。结论：既往重度酒精中毒，尽管长期戒酒，但与内皮功能障碍和一系列血流动力学、血管和代谢异常有关，这表明即使在表面上没有疾病的酗酒者中，心血管和代谢风险也是不利的。J Hyperten 25：367-373(C)2007 Lippincott Williams&Wilkins.
Background Rates of cardiovascular morbidity and mortality are greater in heavy alcoholics than in either teetotallers or light-to-moderate drinkers.Objective On the assumption that factors leading to atherosclerotic damage remain operative even after long-term alcohol withdrawal, we studied the possible mechanisms of raised cardiovascular risk in former heavy alcoholics.Methods Forty-two apparently disease-free, normotensive alcoholics detoxified for 37.1 +/- 31.9 (SD) months, median 24, participated in the study. They were compared with 39 lifetime alcohol-abstaining control subjects, carefully matched for age, sex, body mass index, smoking and dietary habits, physical activity, lipids and fasting glucose. Endothelial function (flow-mediated dilation of brachial artery, high-resolution ultrasound technique), blood pressure, and some parameters of endothelial activation, oxidative stress, vascular inflammation and insulin sensitivity were measured.Results The maximal percentage of flow-mediated dilatation was reduced in detoxified alcoholics (10.1 +/- 4.6 versus 14.9 +/- 7.4, P < 0.001) who also showed significantly higher blood pressure (systolic 127.5 +/- 12.9 versus 118.2 +/- 10.7 mmHg, P < 0.001; diastolic 79.4 +/- 7.1 versus 74.6 +/- 6.4 mmHg, P < 0.01; mean 95.4 +/- 8.2 versus 89.1 +/- 7.3 mmHg, P < 0.001), uric acid (5.0 +/- 1.1 versus 4.4 +/- 0.8 mg/dl, P < 0.05), high-sensitivity C-reactive protein (2.1 +/- 2.0 versus 1.0 +/- 0.9 mg/l, P < 0.01), endothelin-1 (0-38 +/- 0.11 versus 0.17 +/- 0.10 pg/ml, P < 0.001) and fasting insulin (10.4 +/- 4.5 versus 5.6 +/- 1.6 mu U/ml, P < 0.001) with abnormal homeostasis model assessment index of insulin resistance (2.3 +/- 1.1 versus 1.2 +/- 0.4, P < 0.001).Conclusion Previous heavy alcoholism, in spite of longterm withdrawal, is associated with endothelial dysfunction and a wide cluster of haemodynamic, vascular and metabolic abnormalities that indicate an unfavourable cardiovascular and metabolic risk profile even in apparently disease-free former alcoholics. J Hypertens 25:367-373 (c) 2007 Lippincott Williams & Wilkins.