RESUMEN
BACKGROUND AND AIMS: Low vitamin D (vitD) has been linked to increased cardiovascular (CV) risk, but the effects of vitD supplementation are not clarified. We evaluated the impact of vitD normalization on HDL cholesterol efflux capacity (CEC), which inversely correlates with CV risk, the proatherogenic serum cholesterol loading capacity (CLC), adipokine profile and subclinical atherosclerosis. METHODS AND RESULTS: Healthy premenopausal women with vitD deficiency (n = 31) underwent supplementation. Subclinical atherosclerosis was evaluated by flow-mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AIx), measured with standard techniques. HDL CEC and serum CLC were measured by a radioisotopic and fluorimetric assay, respectively. Malondialdehyde (MDA) in HDL was quantified by the TBARS assay. Pre-ß HDL was assessed by 2D-electrophoresis. Serum adipokines were measured by ELISA. VitD replacement restored normal levels of serum 25-hydroxyvitamin D (25OHD) and significantly improved FMD (+4%; p < 0.001), PWV (-4.1%: p < 0.001) and AIx (-16.1%; p < 0.001). Total CEC was significantly improved (+19.5%; p = 0.003), with a specific increase in the ABCA1-mediated CEC (+70.8%; p < 0.001). HDL-MDA slightly but significantly decreased (-9.6%; p = 0.027), while no difference was detected in pre-ß HDL. No change was observed in aqueous diffusion nor in the ABCG1-mediated CEC. Serum CLC was significantly reduced (-13.3%; p = 0.026). Levels of adiponectin were increased (+50.6%; p < 0.0001) and resistin levels were decreased (-24.3%; p < 0.0001). After vitD replacement, an inverse relationship was found linking the ABCA1-mediated CEC with pre-ß HDL (r2 = 0.346; p < 0.001) and resistin (r2 = 0.220; p = 0.009). CONCLUSION: Our data support vitD supplementation for CV risk prevention.
Asunto(s)
Adipoquinas/sangre , Aterosclerosis/prevención & control , Colecalciferol/administración & dosificación , HDL-Colesterol/sangre , Suplementos Dietéticos , Lipoproteínas de Alta Densidad Pre-beta/sangre , Premenopausia/sangre , Deficiencia de Vitamina D/tratamiento farmacológico , Transportador 1 de Casete de Unión a ATP/metabolismo , Adulto , Enfermedades Asintomáticas , Aterosclerosis/sangre , Aterosclerosis/diagnóstico , Aterosclerosis/etiología , Biomarcadores/sangre , Colecalciferol/efectos adversos , Suplementos Dietéticos/efectos adversos , Femenino , Humanos , Prueba de Estudio Conceptual , Resistina/sangre , Factores de Tiempo , Resultado del Tratamiento , Turquía , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Deficiencia de Vitamina D/diagnósticoAsunto(s)
Procedimientos Quirúrgicos Cardiovasculares/efectos adversos , Foramen Oval Permeable/cirugía , Embolia Intracraneal/diagnóstico , Embolia Intracraneal/etiología , Accidente Cerebrovascular/etiología , Trombosis/diagnóstico , Trombosis/etiología , Adulto , Diagnóstico Diferencial , Fibrinolíticos/uso terapéutico , Foramen Oval Permeable/complicaciones , Humanos , Embolia Intracraneal/tratamiento farmacológico , Masculino , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/tratamiento farmacológico , Trombosis/tratamiento farmacológico , Resultado del TratamientoAsunto(s)
Bradicardia/inducido químicamente , Bradicardia/prevención & control , Síncope/inducido químicamente , Síncope/prevención & control , Timolol/administración & dosificación , Timolol/efectos adversos , Administración Oftálmica , Administración Tópica , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
A 56-year-old man presented with typical angina pectoris lasting >20 min associated with precordial ST-segment elevation. Urgent coronary angiography showed critical stenosis in the proximal segment of the left anterior descending artery, which resolved with intracoronary nitrate application. He was subsequently diagnosed with hyperthyroidism secondary to exposure of iodinated contrast agent which is thought to be the cause of the coronary spasm. Symptoms resolved upon treatment with propylthiouracil, slow-release diltiazem, isosorbide mononitrate, and aspirin. This unusual case highlights the importance of considering hyperthyroidism in the differential diagnosis of chest pain and coronary artery spasm. We suggest routine thyroid function testing in patients with coronary spasm.