RELATIONSHIPS BETWEEN CORONARY-ARTERY REA CTION TO ACETYLCHOLINE AND RISK-FACTORS OF ISCHEMIC-HEART-DISEASE

Observation of arterial lumen response to acetylcholine infusion allow s to reveal derangements of endothelial function. In order to study re lationships between functional state of coronary artery endothelium an d presence of risk factors of ischemic heart disease acetylcholine was infused intracoronary at diagnostic angiography to 14 men aged 32-59 years with atypical chest pain and norm-al exercise ECG. In 11 patient s coronary arteries were visually ''normal'' and In 3 patients less th an 50% coronary artery stenoses were found. Ail patients had at least 2 main risk factors (hypercholesterolemia, hypoalphacholesterolemia, h ypertension or age over 40 years). Visual and quantitative analyses of angiograms were used for assessment of coronary artery diameter chang es. Visual evaluation showed that in all cases acetylcholine produced generalized decrease of coronary artery lumen and in 6 patients local constrictions appeared (in 3 patients in Initially ''normal'' segments and in 3 in segments with initially Insignificant stenoses). Quantita tive analysis showed that in all patients generalized constrictive rea ction occured. Mean change of coronary artery diameter was calculated. Average decrease in diameter was -23%. Degree of generalized constric tion correlated with age, serum cholesterol level and total number of major risk factors. At multifactorial discriminant analysis only numbe r of risk factors was independently related to degree of decrease in m ean coronary artery diameter. Thus in individuals with risk factors of Ischemic heart disease acetylcholine Infusion revealed diffuse corona ry artery endothelial dysfunction which was quantitatively linked to n umber of risk factors present.