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CLINICAL STUDY: ENDOTHELIAL FUNCTION

Carotid artery vasoreactivity in response to sympathetic stress correlates with coronary disease risk and is independent of wall thickness

^a Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA

Manuscript received March 7, 2000; revised manuscript received June 23, 2000, accepted August 7, 2000.

Reprint requests and correspondence: Dr. Melvyn Rubenfire, University of Michigan Health System, 24 Frank Lloyd Wright Drive, Ann Arbor, Michigan 48106-0363
mrubenfi{at}umich.edu

OBJECTIVES

We designed a study to determine the carotid artery (CA) response to sympathetic activity and to determine whether the response correlates with coronary risk and is independent of wall thickness (IMT).

BACKGROUND

Brachial artery reactivity in response to wall stress correlates with coronary risk and coronary disease (CAD). The reactivity of the CA, which is susceptible to atherosclerosis, has not been evaluated.

METHODS

The change in diameter of the CA (CA_diam) during a cold pressor test and after nitroglycerin and IMT were measured with ultrasound in 93 men and women at average risk, high risk and with CAD.

RESULTS

At 90 s during a cold pressor test average-risk subjects increased CA_diam by 7.9 ± 3.3%, which was significantly less in the high-risk group (1.5 ± 1.8%), and vasoconstriction occurred in the group of subjects with CAD (–6.9 ± 2.7%) (p < 0.01 for comparisons). There were no differences in response to nitroglycerin. Coronary risk was an independent predictor of the %CA_diam (p < 0.0001). Wall thickness, age, systolic pressure and triglycerides each correlated negatively, and high-density lipoprotein cholesterol correlated positively with %CA_diam. The major variable associated with the %CA_diam was group (p = 0.0001). After adjusting for smoking, age and high-density lipoprotein cholesterol, there was no association between the %CA_diam, and IMT and %CA_diam, but not IMT, was predictive of groups.

CONCLUSIONS

The CA response to a sympathetic stimulus is altered in the presence of coronary risk factors and CAD and appears to reflect endothelial function independent of IMT. Carotid artery reactivity may be a valuable adjunctive noninvasive method to assess coronary risk.

Abbreviations and Acronyms   BA = brachial artery   BSA = body surface area   CA = carotid artery   CAD = coronary artery disease   CAdiam = carotid artery diameter   CPT = cold pressor test   HDL-C = high-density lipoprotein cholesterol   IMT = wall thickness   LDL-C = low-density lipoprotein cholesterol   NO = nitric oxide   Ntg = nitroglycerin

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