Effects of aging on the modulation of coronary flow by endothelium-independent vasodilators in postmenopausal women

Research output: Contribution to journalArticle

Abstract

Background: Despite the rapidly increasing age of the population of women with ischemic heart disease and known age- and lipid-related histological arterial changes that may influence coronary vasoreactivity, the influences of age and lipid levels on coronary vasomotor responses to commonly used endothelium-independent vasodilators have not been reported. Methods: We used intracoronary Doppler ultrasonography and quantitative coronary angiography to determine coronary blood flow before and after the administration of intracoronary nitroglycerin (200 μg) or adenosine (10-5 mol/l) in postmenopausal women. The augmentation of coronary flow in response to these agents was correlated with age, plasma levels of total, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, and triglyceride levels. Results: Nitroglycerin induced a mean ± SD increase in coronary flow of 208.0 ± 172.3% (P < 0.001) in 32 women with a 13.7 ± 23.2% diameter coronary stenosis; of these, 22 had an angiographically normal coronary artery that exhibited a 188.2 ± 144.9% (P < 0.001) increase in flow in response to nitroglycerin, and 10 had an irregular artery (44.0 ± 19.3% stenosis) with a 251.7 ± 224.1% (P = 0.01) nitroglycerin-induced increase in flow. Age and lipid levels did not influence the degree of nitroglycerin-induced flow augmentation in any of the groups. Adenosine caused a 140.0 ± 91.8% (P < 0.001) increase in coronary flow in 24 women with a mean ± SD diameter stenosis of 24.3 ± 29.1%. Adenosine-induced coronary flow augmentation correlated linearly with HDL levels (r = 0.42, P = 0.04) but not with age, total or LDL cholesterol levels, or triglyceride levels. In 13 of the women with a normal study artery, adenosine induced a 157.4 ± 91.3% (P < 0.001) increase in coronary flow, which correlated directly with HDL cholesterol levels (r = 0.61, P = 0.03). Age and lipid levels did not influence adenosine-induced flow augmentation in the 11 women who had an irregular coronary artery (52.9 ± 16.5% stenosis). Conclusion: Age per se does not influence the coronary vasomotor responses of normal or irregular coronary arteries to nitroglycerin or adenosine. The flow responses of angiographically normal coronary arteries to adenosine correlate with HDL cholesterol levels. Nitroglycerin and adenosine may therefore be used to diagnose and treat ischemic heart disease in postmenopausal women regardless of age. Further studies are needed to determine whether the sensitivity of adenosine stress tests is influenced by HDL cholesterol levels.

Original languageEnglish (US)
Pages (from-to)43-51
Number of pages9
JournalCardiology in the Elderly
Volume3
Issue number1
StatePublished - Jan 1 1995

Keywords

  • adenosine
  • aging
  • coronary circulation
  • nitroglycerin

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cardiology and Cardiovascular Medicine

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