Salbutamol-mediated effects on arterial parameters: a tool for subclinical atherosclerosis detection in patients with metabolic syndrome submitted to a cardiac rehabilitation program

Abstract

Introduction. Early detection of atherosclerosis is important in patients with metabolic syndrome (MetS) because cardiovascular diseases are the main cause of mortality in these patients. Cardiac rehabilitation (CR) is one of the best known and studied interventions, which has been shown to be associated with decreased morbidity and mortality of cardiovascular disease. Salbutamolmediated effects on pulse wave represent a practical, valid and reliable non-invasive surrogate marker of subclinical atherosclerosis. Aim of the study We assessed subclinical atherosclerosis in patients with MetS vs. a control group, by measuring aortic pulse wave velocity (PWVAo), the augmentation index and central blood pressure, before and after salbutamol administration, which allows evaluation of the hemodynamic effects of inhaled salbutamol on the arterial parameters. Material and methods We conducted a clinical study on a representative sample of 30 subjects, 67% had metabolic syndrome and 33% did not have metabolic syndrome (control group). We measured all parameters of arterial stiffness: brachial augmentation index (Aixb), aortic augmentation index (Aixao), pulse wave velocity (PWVao), aortic pulse pressure (PPao), central blood pressure (SBPao), before and after administration of two inhalations of Ventolin® (salbutamol). Results The analysis of arterial stiffness parameters (Table 2) showed that PWVao before salbutamol administration was 10.60 m/s in the group with MetS, and 9.11 m/s in the control group, with no significant difference. After salbutamol administration, PWVao was 10.78 m/s in the group with MetS, and significantly lower 8.2 m/s (p=0.008), in the group without MetS. There was a significant difference between the groups regarding PPao (mmHg) before salbutamol (54.040 ± 8.5530, 66.215 ± 15.6326, p=0.03), SBPao (mmHg) before salbutamol (147.14±20.12 vs. 125.34±9.71; p<0.0001) and after salbutamol administration. (138.76±21.97 vs.121.38±8.08; p=0.005). There were no significant differences in brachial Aix (0.03±27.5 vs.-3.04±29.64, p=NS) and aortic Aix (37.72±14.04 vs.36.11±15; p=NS) between the two groups. Conclusions. Early identification of endothelial dysfunction in subjects with metabolic syndrome is important in order to prescribe an optimal cardiac rehabilitation program.