LDL cholesterol is associated with systemic vascular resistance and wave reflection in subjects naive to cardiovascular drugs

Abstract

Background and aim: Low density lipoprotein cholesterol (LDL-C) is a primary risk factor for atherosclerosis, but it is also associated with elevated blood pressure (BP) and future development of hypertension. We examined the relationship between LDL-C and haemodynamic variables in normotensive and never-treated hypertensive subjects. Methods: We recruited 615 volunteers (19-72 years) without lipid-lowering and BP-lowering medication. Supine haemodynamics were recorded using continuous radial pulse wave analysis, wholebody impedance cardiography, and single channel electrocardiogram. The haemodynamic relations of LDL-C were examined using linear regression analyses with age, sex, body mass index (BMI) (or height and weight as appropriate), smoking status, alcohol use, and plasma C-reactive protein, sodium, uric acid, high density lipoprotein cholesterol (HDL-C), triglycerides, estimated glomerular filtration rate, and quantitative insulin sensitivity check index as the other included variables. Results: The mean (SD) characteristics of the subjects were: age 45 (12) years, BMI 27 (4) kg/m 2 , office BP 141/89 (21/13) mmHg, creatinine 74 (14) µmol/l, total cholesterol 5.2 (1.0), LDL-C 3.1 (0.6), triglycerides 1.2 (0.8), and HDL-C 1.6 (0.4) mmol/l. LDL-C was an independent explanatory factor for aortic systolic and diastolic BP, augmentation index, pulse wave velocity (PWV), and systemic vascular resistance index (p<0.05 for all). When central BP was included in the model for PWV, LDL-C was no longer an explanatory factor for PWV. Conclusions: LDL-C is independently associated with BP via systemic vascular resistance and wave reflection. These results suggest that LDL-C may play a role in the pathogenesis of primary hypertension.

Atherogenic index of plasma is related to arterial stiffness but not to blood pressure in normotensive and never-treated hypertensive subjects

“…Although some reports have associated triglycerides and HDL-C with arterial stiffness [14][15][16], all studies do not support this finding [38][39][40]. Moreover, the association of LDL-C with arterial stiffness has been surprisingly weak in the published literature [12,13]. Therefore, our goal was to assess the association between AIP and functional cardiovascular variables using non-invasive recordings of haemodynamics.…”

“…In spite of the dominant role of LDL-C in atherosclerosis, the relationship of LDL-C with PWV is rather weak [12]. Recently, we found that LDL-C was not associated with PWV when the level of BP was taken into account [13], and this finding is concordant with the majority of published papers [12]. High triglycerides concentration in 11,640 and 1,447 subjects, and low HDL-C levels in 15,302 subjects, were associated with increased PWV [14][15][16].…”

“…All subjects were from an ongoing study with the primary aim to examine haemodynamics in primary and secondary hypertension versus normotensive controls (DYNAMIC study; ClinicalTrails.gov identifier NCT01742702). The participant recruitment was recently published in the form of a study flow-chart [13], and altogether 615 from 1349 subjects were included. The exclusion criteria for the study were volunteers taking (1) statin or other lipid-lowering or BP-lowering medication, or with a history of (2) coronary artery disease, (3) stroke, (4) heart failure, (5) valvular heart disease, (6) diabetes, (7) chronic kidney disease, (8) secondary hypertension, (9) alcohol or substance abuse, (10) psychiatric illness other than mild depression or anxiety, or (11) abnormal heart rhythm other than sinus.…”

“…Altogether 230 (37.4%) of the 615 persons used some medications. Full description about medicine consumption has been described in our previous study [13].…”

“…To our knowledge, the association of AIP with haemodynamic variables has not been previously examined. Due to the weak association of LDL-C with arterial stiffness in our previous report [13], our objective in this cross-sectional study was to examine the associations of AIP with functional haemodynamic variables, and especially to test the hypothesis whether AIP is related to arterial stiffness.…”