An easy and inexpensive way to lower cholesterol?
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Cholesterol↗
Biomedical subjects
J B Gordon
Publications and source records attributed to J B Gordon.
Endothelium-dependent dilation of the coronary microvasculature is impaired in dilated cardiomyopathy.
Dilator reserve of the coronary microvasculature is diminished in patients with dilated cardiomyopathy. Although increased extravascular compressive forces, tachycardia, and increased myocardial mass can explain some impairment, recent evidence suggests the possibility of intrinsic microvascular disease. We tested the hypothesis that impairment of endothelium-dependent dilation of the microvasculature could be a contributing mechanism. We infused the endothelium-dependent dilator acetylcholine (Ach) (10(-8) to 10(-6) M) and the smooth muscle vasodilator adenosine (AD) (10(-6) to 10(-4) M) into the left anterior descending coronary artery in eight patients with dilated cardiomyopathy (mean ejection fraction, 28%) and seven controls (atypical chest pain). Small vessel resistance was assessed by measuring coronary blood flow (CBF) at constant arterial pressure with a Doppler velocity catheter (corrected for cross-sectional area by angiography). With Ach, control patients increased CBF 232 +/- 40% (mean +/- SEM), whereas CBF did not significantly change in cardiomyopathy patients (41 +/- 24%) (p less than 0.0001, control vs. cardiomyopathy). With AD, control patients increased CBF 422 +/- 56% and cardiomyopathy patients increased CBF 268 +/- 43% (p = 0.13). An index of the proportion of coronary flow reserve attributable to endothelium-dependent vasodilation was obtained by standardizing each patient's Ach dose response to his maximal AD flow response. In seven control patients receiving both Ach and AD, 56 +/- 9% of the maximal AD flow response was attained with the endothelium-dependent vasodilator Ach, whereas in seven cardiomyopathy patients receiving both Ach and AD, only 23 +/- 14% of the maximal AD response was attained (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Acetylcholine↗
Persistent dysfunction of regenerated endothelium after balloon angioplasty of rabbit iliac artery.
This study investigated the vasodilator function of endothelium that regenerated after balloon angioplasty and the relation of this function to the extent of vascular injury and to subsequent intimal proliferation. Balloon angioplasty was performed in the left iliac artery of 47 New Zealand White rabbits. Vascular responses were examined in vitro 2 and 4 weeks after a "severe" injury (3.0-mm balloon) or a "moderate" injury (2.5-mm balloon). Both degrees of balloon injury caused complete endothelial denudation. Endothelial regrowth 2 weeks after either injury was confirmed histologically. Although the regenerated cells had irregular sizes and polygonal shapes and lacked the typical alignment in the direction of blood flow, immunocytochemical staining for factor VIII-related antigen identified these cells as endothelium. To study the vasodilator function of regenerated endothelium, rings of balloon-injured and control (contralateral) iliac arteries were suspended in organ chambers for recording of isometric force. Endothelium-dependent relaxation of balloon-injured vessels to acetylcholine and to the calcium ionophore A23187 were reduced at 2 and at 4 weeks after severe injury. After moderate injury, endothelium-dependent relaxations to these agents were reduced at 2 weeks but had normalized by 4 weeks. Endothelium-independent relaxation to sodium nitroprusside, however, was preserved in all study groups. Morphometric analysis revealed an inverse correlation between the degree of intimal thickening and maximal relaxation to acetylcholine (r = 0.45, p less than 0.01). Thus, there is a persistent attenuation of receptor- and nonreceptor-mediated endothelium-dependent relaxations after arterial injury. The regenerated cells have an altered morphological appearance, but staining for factor VIII-related antigen confirms their endothelial origin. The degree and duration of endothelial dysfunction depends on the severity of the initial injury and is related to the extent of intimal thickness.
Acetylcholine↗
There ought to be a law.
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Drug Prescriptions↗
Putting practice into law.
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Ethics, Medical↗
Analysis of aortic valve gradients by transseptal technique: implications for noninvasive evaluation.
The peak instantaneous aortic valve gradient derived from Doppler echocardiography is commonly used to predict the severity of aortic stenosis. Peak instantaneous gradient should not be equated with the mean gradient or "peak to peak" gradient measured at cardiac catheterization. The primary purpose of this study is to assess the relationship between the aortic valve gradients, using a two-catheter transseptal technique in 102 patients with aortic stenosis, mixed aortic stenosis and regurgitation, and following aortic valve replacement. These cases were drawn from a series of 111 consecutive transseptal procedures for patients with isolated aortic valve disease. No major complications occurred, and the most common reason for technical failure was inability to engage the atrial septum in postoperative patients. Although the peak instantaneous gradient correlates well with the mean gradient in aortic stenosis (r = .94, P less than .001), mixed stenosis and regurgitation (r = .95, P less than .001), and after aortic valve replacement (r = .86, P less than .001), it systematically overestimates both the mean gradient and the peak to peak gradient. Neither the peak instantaneous nor the mean gradient correlates highly with aortic valve area in aortic stenosis (r = -.48, P less than .01 peak; r = -.58, P less than .001 mean gradient), mixed aortic stenosis and regurgitation (r = -.39, P NS peak; r = -.42, P NS mean gradient) or following aortic valve replacement (r = -.26, P NS peak; r = -.53, P less than .01 mean gradient). Systolic time intervals also were analyzed from the simultaneous left ventricular and ascending aortic pressure tracings.(ABSTRACT TRUNCATED AT 250 WORDS)
Aortic Valve↗
Beta-adrenergic receptor number and adenylate cyclase function in denervated transplanted and cardiomyopathic human hearts.
To test the hypothesis that there is up-regulation of beta-adrenergic receptor density or supersensitivity of beta-adrenergic receptor-stimulated adenylate cyclase in the denervated transplanted human heart, we studied myocardium from transplanted, normal, and failing hearts. Myocardium was obtained from 10 patients 9 +/- 3 months after cardiac transplantation, from 10 patients without cardiac disease, and from eight patients with symptomatic congestive heart failure due to idiopathic cardiomyopathy. beta-Adrenergic receptor density in transplanted myocardium (15 +/- 3 fmol/mg protein, 1.20 +/- 0.14 fmol/mg DNA) was not different from that in normal myocardium (22 +/- 3 fmol/mg protein, 1.46 +/- 0.13 fmol/mg DNA; p = NS for both). In myocardium from cardiomyopathic hearts, beta-adrenergic receptor density was markedly reduced (8 +/- 2 fmol/mg protein, 0.84 +/- 0.13 fmol/mg DNA; p less than 0.05 and p less than 0.01 vs. normal myocardium, respectively). Likewise, the response of adenylate cyclase to isoproterenol in transplanted myocardium was not significantly different from that in normal myocardium, but the response was markedly depressed in cardiomyopathic myocardium. Although forskolin-stimulated adenylate cyclase activity was similar in all three groups, guanine nucleotide-stimulated adenylate cyclase activity was markedly reduced in transplanted myocardium (20 +/- 17 vs. 78 +/- 13 pmol/mg/min for normal myocardium, p less than 0.01) and to a lesser degree in cardiomyopathic myocardium (39 +/- 14 pmol/mg/min, p less than 0.03 vs. normal myocardium). Thus, there is no evidence of beta-adrenergic receptor up-regulation or supersensitivity in denervated transplanted human myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenylyl Cyclases↗
Atherosclerosis influences the vasomotor response of epicardial coronary arteries to exercise.
We studied the vasomotion of epicardial coronary arteries during exercise and tested the hypotheses that abnormal vasoconstriction is related to the presence of atherosclerosis and may be related to endothelial dilator dysfunction. During cardiac catheterization quantitative coronary angiography was performed in 21 patients during supine bicycle exercise. 21 of 28 smooth, angiographically normal vessel segments dilated (14.0 +/- 1.8%) during exercise; four smooth segments did not change whereas only three constricted. In contrast, 15 of 16 vessel segments with irregularities constricted in response to exercise (17.0 +/- 0.1%) with only one segment dilating. All 10 stenotic segments constricted to exercise (23 +/- 4%). Six patients also received intracoronary acetylcholine before exercise to test endothelium-dependent dilator function. In five of six patients all nine vessel segments showed the same directional response to acetylcholine and exercise. Three irregular and two stenotic segments constricted with acetylcholine (51 +/- 21%) and exercise (9.0 +/- 0.6%). In contrast, four smooth segments dilated to acetylcholine (19 +/- 6%) and exercise (9 +/- 1%). Both exercise and acetylcholine generally dilated smooth but constricted irregular and stenosed coronary segments. It appears likely that atherosclerosis plays an important role in the abnormal vasomotion of diseased coronary arteries during exercise and the pattern of abnormality suggests impairment of vasodilator function.
Acetylcholine↗
Developmental effects of hypoxia and indomethacin on distribution of vascular resistances in lamb lungs.
The influence of postnatal age on the distribution of vascular resistances was studied in in situ, isolated, blood perfused lungs of lambs aged 6-12 h, 2-4 d, 2 wk, and 1 mo. The pressure gradients across the upstream, downstream, and compliant middle segments were determined by an inflow-outflow occlusion technique during mild hyperoxia (FIO2 = 0.28) and severe hypoxia (FIO2 = 0.04) under control and indomethacin-treated conditions. The greatest response to hypoxia was seen in the middle segment. A lesser, but significant response was also seen in the upstream segment. Indomethacin accentuated the hypoxic response of the total circuit and the middle segment at all ages, and the upstream segment in the two younger age groups. An age-dependent increase in total hypoxic reactivity was seen in control lungs, but not in indomethacin-treated lungs. When the pressure gradient across the middle segment alone was considered, an age-dependent increase in hypoxic reactivity was seen in controls and a decrease was seen in indomethacin-treated lungs. In contrast there were no age-dependent changes in the hypoxic responses of the upstream or downstream segments. These data suggest that the predominant site of hypoxic pulmonary vasoconstriction and dilator prostaglandin activity lies within the middle gradient in newborn lamb lungs. Furthermore, the age-dependent changes in the hypoxic response of the middle gradient appear to be altered by the modulating influence of dilator prostaglandins.
Aging↗
Effects of glucocorticoids on Na+/H+ exchange and growth in cultured vascular smooth muscle cells.
We have examined the effects of hydrocortisone on growth and Na+/H+ exchange in cultured rat aortic vascular smooth muscle cells (VSMC). Hydrocortisone (2 microM) treatment of growth-arrested VSMC significantly decreased VSMC growth in response to 10% calf serum assayed by 3H-thymidine incorporation and cell number at confluence. This effect was associated with the appearance of an altered cell phenotype characterized by large, flat VSMC that did not form typical "hillocks." Na+/H+ exchange was also altered in hydrocortisone-treated cells assayed by dimethylamiloride-sensitive 22Na+ influx into acid-loaded cells or by intracellular pH (pHi) change using the fluorescent dye BCECF. Resting pHi was 7.25 +/- 0.04 and 7.15 +/- 0.05 in control and hydrocortisone-treated cells, respectively (0.1 less than P less than 0.05). Following intracellular acidification in the absence of external Na+, pHi recovery upon addition of Na+ was increased 89% in hydrocortisone-treated cells relative to control. This was due to an increase in the Vmax for the Na+/H+ exchanger from 17.5 +/- 2.4 to 25.9 +/- 2.0 nmol Na+/mg protein x min (P less than 0.01) without a significant change in Km. Treatment of VSMC with actinomycin D (1 microgram/ml) or cycloheximide (10 microM) completely inhibited the hydrocortisone-mediated increase in Na+/H+ exchange, indicating a requirement for both RNA and protein synthesis. Because hydrocortisone altered the Vmax for Na+/H+ exchange, in contrast to agonists such as serum or angiotensin II which alter the Km for intracellular H+ or extracellular Na+, respectively, we studied the effect of hydrocortisone on activation of Na+/H+ exchange by these agonists. In cells maintained at physiological pHi (7.2), the initial rate (2 min) of angiotensin II-stimulated alkalinization was increased 66 +/- 39% in hydrocortisone-treated compared with control cells. Hydrocortisone caused no change in angiotensin II-stimulated phospholipase C activity assayed by measurement of changes in intracellular Ca2+ or diacylglycerol formation. However, angiotensin II and serum stimulated only small increases in Na+/H+ exchange in acid-loaded (pHi = 6.8) hydrocortisone-treated cells. These findings suggest that hydrocortisone-mediated increases in VSMC Na+/H+ exchange occur in association with a nonproliferating phenotype that has altered regulation of Na+/H+ exchange activation. We propose that hydrocortisone-mediated growth inhibition may be a useful model for studying the role of Na+/H+ exchange in cell growth responsiveness.
Angiotensin II↗
Dilation of normal and constriction of atherosclerotic coronary arteries caused by the cold pressor test.
Increased vascular constriction has been observed at the site of atherosclerotic lesions, suggesting an association between atherosclerosis and altered vascular tone. While atherosclerosis may increase sensitivity to exogenous vasoconstrictors, little is known about the response of normal and atherosclerotic coronary arteries to an exogenous stimulus that excites the sympathetic nervous system. Therefore, we studied the response to cold pressor test (CPT) using quantitative angiography and Doppler flow velocity measurements in eight patients with angiographically normal coronary arteries (group I), nine patients with mild coronary atherosclerosis (less than 50% diameter narrowing) (group II), and 13 patients with advanced coronary stenoses (greater than 50% diameter narrowing) (group III). In 31 segments of angiographically smooth arteries in group I, the CPT produced vasodilation from a control mean diameter of 2.68 +/- 0.09 (mean +/- SE) to 2.99 +/- 0.09 mm at peak CPT (p less than 0.001), a 12 +/- 1% increase in diameter. In group II, 27 irregular segments constricted to peak CPT from a mean control diameter of 1.82 +/- 0.12 to 1.66 +/- 0.12 mm (p less than .001), a 9 +/- 1% decrease, while 10 smooth segments dilated from a mean control diameter of 1.98 +/- 0.11 mm to 2.34 +/- 0.15 mm (p less than .01), a 19 +/- 2% increase in diameter. Likewise, in group III, the 17 stenotic segments constricted from 1.16 +/- 0.09 to 0.89 +/- 0.09 mm (p less than .001), a 24 +/- 6% decrease; the irregular segments also constricted from 2.44 +/- 0.11 to 2.22 +/- 0.12 mm (p = .002), a 10 +/- 2% decrease. In contrast, two smooth segments dilated from 2.98 to 3.23 mm (mean), an 8% increase in diameter. Coronary blood flow increased 65 +/- 4% (mean) during CPT in group I, it increased 15 +/- 6% in group II, and it decreased 39 +/- 8% in group III. The vasodilator response in four normal patients was partly inhibited by the administration of intracoronary propranolol (17 +/- 3% increase during control, 10 +/- 2% increase after propranolol, 41% less dilation; p = .002). We conclude that the response of normal coronary arteries to the CPT test is dilation, in part related to beta-adrenoreceptor stimulation and possibly flow-mediated endothelial dilation or alpha 2-adrenergic activity. The paradoxical vasoconstrictor response induced by atherosclerosis may represent altered catecholamine sensitivity and/or a defect in endothelial vasodilator function. The presence of atherosclerosis impairs vasodilator responses and thus may contribute to the pathogenesis of myocardial ischemia.
Adult↗
Age-dependent effects of indomethacin on hypoxic vasoconstriction in neonatal lamb lungs.
Although smooth muscle is abundant in the pulmonary vessels of young animals at birth, it is not clear if these vessels respond more vigorously to hypoxia than the less muscular vessels of older neonates. To determine the effect of age on the pulmonary vascular response to hypoxia during the neonatal period in a single species, we measured the steady-state stimulus-response relationship between inspired oxygen tension (200, 50, 30 and 0 mm Hg) and pulmonary artery pressure-flow curves in isolated blood perfused lungs from 2- to 4- and 12- to 14-day-old lambs. Hypoxic vasoconstriction was attenuated in the younger newborns at an inspired oxygen tension of 50 mm Hg, but not at the other oxygen tensions. To determine if this age-related difference was due to differences in modulation of hypoxic vasoconstriction by cyclooxygenase products, we assayed the metabolite of prostacyclin, 6-keto-prostaglandin F1 alpha in the perfusate and determined the effects of indomethacin (40 micrograms/ml) on the hypoxic stimulus-response relationship. There was no age-related difference in perfusate concentration of 6-keto-prostaglandin F1 alpha at any oxygen tension. However, indomethacin reversed the age-dependent attenuation of hypoxic vasoconstriction at inspired oxygen tension = 50 mm Hg such that in indomethacin-treated lungs pulmonary vasomotor tone was higher in 2- to 4-day-old lungs than in 12- to 14-day-old lungs. This marked enhancement of hypoxic reactivity by indomethacin in the younger lambs suggests that in isolated neonatal lamb lungs cyclooxygenase products exerted a vasodilatory modulation of hypoxic vasoconstriction that decreased with age.
6-Ketoprostaglandin F1 alpha↗
Angina pectoris as the initial manifestation of an aortocaval fistula.
Spontaneous aortocaval fistula is an unusual disorder associated with abdominal aortic aneurysms and with the onset of high-output heart failure. A novel case of spontaneous aortocaval fistula formation that presented with angina is described. Increased myocardial oxygen demand due to elevated myocardial wall tension, inotropic state, and heart rate is the apparent contributing factor. Clinical evidence of ischemic heart disease and heart failure resolved with surgical correction of the shunt. Spontaneous aortocaval fistula formation can be a precipitating cause of new-onset angina.
Angina Pectoris↗
Effects of indomethacin on estradiol-induced attenuation of hypoxic vasoconstriction in lamb lungs.
To determine whether cyclooxygenase products mediated the attenuation of hypoxic pulmonary vasoconstriction induced by estradiol, we measured pulmonary arterial pressure at a flow of 50 ml X min-1 X kg-1 (Ppa50) during steady-state exposures to inspired O2 tensions (PIO2) between 0 and 200 Torr in isolated lungs of juvenile ewes. Intramuscular estradiol (10 mg) 44-60 h before study significantly decreased perfusate concentrations of 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha), the stable metabolite of the pulmonary vasodilator, prostacyclin, but did not significantly affect the stimulus-response relationship between PIO2 and Ppa50. Estradiol (20 mg) 3-5 days before study increased 6-keto-PGF1 alpha concentrations and decreased Ppa50 at PIO2 of 10, 30, and 50 Torr. Indomethacin added to the perfusate of these lungs reduced 6-keto-PGF1 alpha to undetectable levels and altered the estradiol-induced attenuation, increasing Ppa50 at PIO2 of 10 and 30 Torr, but decreasing Ppa50 at PIO2 of 200 Torr. Despite these effects, Ppa50 remained lower than the values measured in lungs not treated with estradiol. These results suggest that the estradiol-induced attenuation of the hypoxic stimulus-response relationship was mediated only in part by cyclooxygenase products, the net effects of which were vasodilation at PIO2 of 10 and 30 Torr, but vasoconstriction at PIO2 of 200 Torr.
6-Ketoprostaglandin F1 alpha↗
Comparison of hospitalization between nursing home and community residents.
The authors prospectively identified 96 consecutive nursing home residents (NHR) admitted to the medical wards of their affiliated hospitals to determine the outcome of hospitalization for these patients in comparison with 88 admissions in a similarly aged community residents (CR) population. Nursing home and community resident groups were similar in age, sex, marital status, and distribution among the four study hospitals. Dementia was a more common preexisting diagnosis in NHR than in CR. Reasons for admission differed between the two groups. Although NHR experienced a longer hospitalization than CR, frequency and duration of intensive care unit admissions were similar. Fatal outcome occurred more commonly in NHR compared with CR (27 v 11%, P less than .001). Predictors of mortality were examined. Nursing home residents also experienced a higher mortality than CR within the six months after hospitalization (35 v 20%, P less than .005).
Acute Disease↗
High-frequency ventilation attenuation of hypoxic pulmonary vasoconstriction. The role of prostacyclin.
In order to determine the effects of high-frequency ventilation on the pulmonary vascular response to hypoxia, we assessed pulmonary vascular resistance at 2 levels of inspired oxygen tension (PlO2), 200 and 30 mmHg, during conventional and high-frequency ventilation in the isolated, blood-perfused lungs of 10 sheep, 5 treated with indomethacin (40 micrograms/ml of perfusate) and 5 untreated. Resistance was assessed by measuring pulmonary artery pressure-flow curves generated over a wide range of flows (20 to 140 ml X min-1 X kg body wt-1). Conventional ventilation was provided by an animal ventilator at a rate of 10 min-1 and a tidal volume of 10 ml X kg body wt-1. High-frequency ventilation was provided by a flow interrupter at a rate of 1,200 min-1 and a tidal volume less than 1.5 ml X kg body wt-1. In the 5 untreated lungs, the normoxic pressure-flow curve was unaltered by high-frequency ventilation, but the hypoxic pulmonary vasoconstrictor response was significantly attenuated. Furthermore, the net rate of change of 6-keto-prostaglandin F1 alpha concentration in the perfusate during hypoxia was significantly greater with high-frequency ventilation (65.4 +/- 8.9 pg X ml-1 X min-1) than with conventional ventilation (2.8 +/- 18.7 pg X ml-1 X min-1). In the 5 indomethacin-treated lungs, production of 6-keto-prostaglandin F1 alpha was markedly depressed, and the attenuation of the hypoxic vasoconstrictor response by high-frequency ventilation was abolished.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Prostaglandins and estradiol-induced attenuation of hypoxic pulmonary vasoconstriction.
Pretreatment with estradiol (20 mg IM) attenuated vasoreactivity to decreases in inspired PIO2, lowered baseline resistance measured under conditions of maximal vasodilation (PIO2 = 0 mm Hg), and appeared to increase prostaglandin release in isolated, blood-perfused lungs of juvenile female sheep. Indomethacin (40 micrograms/ml) inhibited prostaglandin release and restored hypoxic vasoreactivity in estrogen-treated lungs, but did not alter the estrogen-induced decrease in baseline resistance. These results suggest that estradiol enhanced the production of prostaglandins which secondarily attenuated hypoxic vasoreactivity. The estradiol-induced decrease in baseline resistance, however, must have been mediated by some other mechanism.
6-Ketoprostaglandin F1 alpha↗
Social network analysis and intervention with the elderly.
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Aged↗