Association between rheology and components of lipoproteins in human blood. Results from the MONICA project.

Köenig, Wolfgang; Sund, M.; Ernst, Edzard; Mraz, W.; Hombach, Vinzenz; Keil, Ulrich

doi:10.1161/01.cir.85.6.2197

Cited by 89 publications

(45 citation statements)

References 36 publications

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“…31 A positive relationship between plasma viscosity and LDL cholesterol, as well as between plasma viscosity and triglycerides, which may be explained by rheological effects of molecules of high molecular mass, are consistent with the results of other studies. 19,[32][33][34][35][36][37] The negative bivariate correlation between plasma viscosity and HDL cholesterol seems to be equivocal but is nevertheless consistent with the findings of other authors. 36 -38 However, the relationship remained no longer significant after performing the MLRA.…”

Section: Discussionsupporting

confidence: 85%

Relationship Between Plasma Viscosity and the Severity of Coronary Heart Disease

Junker

Heinrich

Ulbrich

et al. 1998

ATVB

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Abstract-Several studies have indicated that plasma viscosity contributes to cardiovascular risk in men. So far, a significant relationship between plasma viscosity and the severity of coronary heart disease has not been found. Thus, the present study is the first to report on the relationship of plasma viscosity and the severity of coronary heart disease. In a collective of 1142 male myocardial infarction patients, plasma viscosity and additional laboratory parameters were determined. Atherosclerotic changes were quantified by coronary angiography. Patients were divided into groups without any, and with one to three stenosed vessels. We found a positive relationship between plasma viscosity and the severity of coronary heart disease, even after adjusting groups for age, fibrinogen, and use of diuretics. Mean plasma viscosity ranged from 1.141Ϯ0.035 mPa s in patients without stenosed vessels to 1.162Ϯ0.044 mPa s in patients who had three coronary vessels with stenoses Ͼ50%. Differences between the groups were significant (PϽ0.001 to 0.05), with two exceptions: differences between patients without any and with one stenosed vessel, as well as between patients with one and two stenosed vessels, did not reach the significance level. On the whole, we can give further support to the hypothesis that cardiovascular risk factors and coronary heart disease may be linked by plasma viscosity.(Arterioscler Thromb Vasc Biol. 1998;18:870-875.)Key Words: coronary heart disease Ⅲ myocardial infarction Ⅲ coronary risk factor Ⅲ blood rheology Ⅲ fibrinogen I n the prospective Caerphilly and Speedwell studies, as well as in the MONICA project, plasma viscosity was indicated as a predictive risk factor for CHD. 1,2 In other studies, high plasma viscosity was shown to lead to an increased risk of acute MI in patients with unstable angina pectoris. 3,4 Furthermore, a relationship of an early increase in plasma viscosity during acute MI and reinfarction or death was shown. 5 An elevation of plasma viscosity was found in patients with severe unstable angina pectoris compared with patients with stable angina pectoris and to healthy individuals. 6-8 Additionally, an elevated plasma viscosity in patients with stable angina pectoris, 9 even without coronary artery stenosis at angiography, 10 could be demonstrated. In the MONICA project, geographical differences in plasma viscosity between populations differing in the CHD event rates were found. 11 Evidently, plasma viscosity contributes to the cardiovascular risk and may be of special importance in areas of reduced blood flow, as commonly occurs in patients with advanced atherosclerosis. 12 Lowe et al 13 suggested that blood viscosity is related to the extension of CHD. The study that proposed this suggestion, however, consisted only of a small group of patients, and therefore the results require further investigation. Moreover, in this study, plasma viscosity was not significantly elevated in patients with extensive CHD compared with a control group and to patients with less severe CHD. Thu...

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Section: Discussionsupporting

confidence: 85%

Relationship Between Plasma Viscosity and the Severity of Coronary Heart Disease

Junker

Heinrich

Ulbrich

et al. 1998

ATVB

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“…This observation is in line with results from the MONICA project 11 that show a positive association between apoA-II concentrations and plasma viscosity. The association between LpA-I/A-II seems to be stronger for disaggregation shear rate than for AI, suggesting an increased influence on the binding energy of these lipoparticles on RBC aggregation.…”

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confidence: 91%

Influence of HDL subfractions on erythrocyte aggregation in hypercholesterolemic men. PCVMETRA Group.

Razavian

Atger

Giral

et al. 1994

Arterioscler Thromb

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Recent studies have suggested that rheological mechanisms may be involved in the pathogenesis of ischemic syndromes in hyperlipidemias. We investigated the association between erythrocyte aggregation and components of lipoproteins in the blood of 60 normotensive, hypercholesterolemic men aged 45±8 years. The rheological parameters assessed were aggregation index (AI) and disaggregation shear rate threshold (yt) as determined by laser reflectometry, plasma fibrinogen, total serum protein, and hematocrit. The lipoprotein variables included total cholesterol, triglycerides, highdensity lipoprotein (HDL) cholesterol and its subfractions HDL 2 cholesterol and HDL3 cholesterol, apolipoprotein (apo) B, apoA-I, HDL particles containing apoA-I without apoA-II (LpA-I), and HDL particles containing both apoA-I and apoA-II (LpA-I/A-II). Covariables considered for possible confounding effects were age, body mass index, and smoking behavior. Fibrinogen, total serum protein, and both aggregation parameters (AI and yt) were elevated in this hypercholesterolemic population. Univariate analysis showed that both T he fluidity of blood plays an important role in the physiological behavior of the circulation, and its alteration might promote cardiovascular complications in situations associated with low-flow states. 1In this condition red blood cells (RBCs) aggregate due to the increase in the bridging force of high-molecularweight plasma proteins.12 Among these proteins, some are considered to be cardiovascular risk markers (eg, lipoproteins, fibrinogen) and are associated with increased plasma and whole-blood viscosity.313 Associations between rheology and components of lipoproteins in human blood are reported. Studies in patients with various forms of hyperlipoproteinemia show a concentration-dependent increase in plasma viscosity for lowdensity lipoprotein cholesterol (LDL-C) and chylomicrons and hence, for total triglycerides. 9 ' 10 These earlier studies are in line with the positive linear correlation of plasma viscosity with total cholesterol and apolipoprotein (apo) A-II and apoB observed in a recent study. 11Moreover, both blood viscosity 11 and erythrocyte aggregation 12 are negatively related to high-density lipoprotein cholesterol (HDL-C) concentration, which is known to be inversely correlated with coronary heart disease risk. 14 Furthermore, HDL may also be separated according to apolipoprotein composition, leading to at least two species of particles: LpA-I, which contains apoA-I without apoA-II, and LpA-I/A-II, which contains both apoA-I and apoA-II. 15 These heterogeneous HDL subfractions seem to have distinct metabolic roles, but the specific effect of one or another particle on the atherosclerotic process remains unclear. 1621 In the present study we investigated the relation of lipoprotein components, and especially HDL subfractions, to the aggregation and disaggregation of RBCs in a population of asymptomatic, hypercholesterolemic, normotriglyceridemic, normotensive subjects. Methods Selection of Su...

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“…29,30 For all of these reasons, we suggest that plasma viscosity merits further studies as a predictor of cardiovascular risk.…”

Section: Discussionmentioning

confidence: 95%

Plasma Viscosity and the Risk of Coronary Heart Disease

Köenig

Sund²,

Filipiak³

et al. 1998

ATVB

135

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Abstract-Plasma viscosity is determined by various macromolecules, eg, fibrinogen, immunoglobulins, and lipoproteins.It may therefore reflect several aspects involved in cardiovascular diseases, including the effects of classic risk factors, hemostatic disturbances, and inflammation. We examined the association of plasma viscosity with the incidence of a first major coronary heart disease event (CHD; fatal and nonfatal myocardial infarction and cardiac death; nϭ50) in 933 men aged 45 to 64 years of the MONICA project of Augsburg, Germany. The incidence rate was 7.23 per 1000 person-years (95% confidence interval [CI], 5.37 to 9.53), and the subjects were followed up for 8 years. All suspected cases of an incident CHD event were classified according to the MONICA protocol. There was a positive and statistically significant unadjusted relationship between plasma viscosity and the incidence of CHD. The relative risk of CHD events associated with a 1-SD increase in plasma viscosity (0.070 mPa ⅐ s) was 1. Key Words: viscosity Ⅲ plasma Ⅲ coronary heart disease Ⅲ incidence Ⅲ prospective studies P ositive associations of various factors, like smoking, blood pressure, and cholesterol, with the incidence of CHD are well established. However, high-risk patients identified by hypertension, smoking, and elevated cholesterol accounted for only 32% of all future MIs in one study. 1 Furthermore, event rates vary considerably across countries, a fact that cannot be explained by differences in conventional risk factors.2,3 Plasma viscosity, a major determinant of blood flow in the microcirculation, may be one explanation of such a difference. 4 Thus, other factors might contribute to the pathogenesis of CHD. Evidence from prospective studies has implicated fibrinogen as a major independent cardiovascular risk factor. 5Only three prospective studies are available wherein plasma viscosity (which is determined to some extent by fibrinogen) was measured along with other risk-related parameters. Plasma viscosity, as well as fibrinogen and white blood cell count, was positively associated with the incidence of CHD events in a population-based study of middle-aged men.6,7 Plasma viscosity and fibrinogen were also associated with incident CHD and stroke in a study of older men and women 8 and with recurrence of stroke in another study. 9In the first cross-sectional study of the MONICA Project, Augsburg, 1984 to 1985, plasma viscosity but not fibrinogen was measured in addition to conventional risk factors. This report assesses the prognostic impact of plasma viscosity for a first major incident CHD event in 45-to 64-year-old German men.

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Association between rheology and components of lipoproteins in human blood. Results from the MONICA project.

Cited by 89 publications

References 36 publications

Relationship Between Plasma Viscosity and the Severity of Coronary Heart Disease

Relationship Between Plasma Viscosity and the Severity of Coronary Heart Disease

Influence of HDL subfractions on erythrocyte aggregation in hypercholesterolemic men. PCVMETRA Group.

Plasma Viscosity and the Risk of Coronary Heart Disease

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