Impaired endothelium-dependent vasodilation of coronary resistance vessels in hypercholesterolemic patients.

To determine the relationship between hypercholesterolemia and the endothelial function of coronary resistance vessels, we studied the changes in coronary blood flow (CBF) in response to acetylcholine, an endothelium-dependent vasodilator, and adenosine, an endothelium-independent vasodilator, in patients with hypercholesterolemia (n = 17) and in control patients (n = 17). All patients had normal epicardial coronary arteries. Serial 2-min infusions of acetylcholine, at 3 micrograms/min and 30 micrograms/min, caused a dose-dependent increase in CBF in each group. The acetylcholine-induced maximal increases in CBF were inversely correlated with the serum cholesterol level (r = -0.55, p < 0.01), and were significantly smaller in the hypercholesterolemic patients than in control patients. However, the adenosine-induced increases in CBF were similar in the two groups. These results suggest that the endothelium-dependent vasodilation of resistance vessels is lessened in patients with hypercholesterolemia even before the formation of atherosclerotic stenotic lesions in epicardial coronary arteries, and that hypercholesterolemia impairs endothelium-dependent vasodilation of coronary resistance vessels.