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European Heart Journal Advance Access published online on November 5, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp459
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Coronary microcirculatory vasodilator function in relation to risk factors among patients without obstructive coronary disease and low to intermediate Framingham score

Ronen Rubinshtein1, Eric H. Yang1, Charanjit S. Rihal1, Abhiram Prasad1, Ryan J. Lennon2, Patricia J. Best1, Lilach O. Lerman3 and Amir Lerman1,*

1 Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, MB 4-523, 200 First Street SW, Rochester, MN 55905, USA
2 Division of Biostatistics, Mayo Clinic, Rochester, MN, USA
3 Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA

Received 5 June 2009; revised 21 August 2009; accepted 18 September 2009 * Corresponding author. Tel: +1 507 255 4152, Fax: +1 507 255 2550, Email: lerman.amir{at}mayo.edu

Aims: The study aim was to evaluate the relation between the Framingham risk score (FRS) and the presence of coronary risk factors to coronary microcirculatory vasodilator function in patients with early coronary atherosclerosis.

Methods and results: We evaluated 1063 patients (age: 50 ± 12 years, 676 (64%) females) without significant narrowing (<30%) on coronary angiography who underwent invasive assessment of coronary endothelial function. Coronary blood flow (CBF) in response to the endothelium-dependent vasodilator acetylcholine was evaluated as well as the microvascular (endothelium-independent) coronary flow reserve (CFR) in response to intracoronary adenosine. Coronary blood flow and CFR were analysed in relation to the FRS and the presence of traditional and novel risk factors. The estimated 10 years risk in this group was 5.4 ± 5.2%. Higher FRS was associated with lower CBF in men (P = 0.008), and was a univariate predictor of lower CFR (P = 0.012) in all patients. Multivariable analysis identified a higher FRS (P < 0.001), female sex (P < 0.001) and a positive family history of coronary disease (P = 0.043) as independent predictors of reduced CFR.

Conclusion: In patients without obstructive coronary disease, a higher FRS was an independent predictor of reduced CFR. The current study provides insight into the relation between cardiac risk profile and coronary microcirculatory function, and suggests that impaired microcirculatory vasodilator function may be present even in patients with a low to intermediate Framingham score.

Key Words: Coronary atherosclerosis • Female • Framingham risk score • Endothelial function • Microcirculation


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