Patients with
hypercholesterolemia have a reduced response to
endothelium-dependent vasodilators. However, the regulatory function of the endothelium on vascular tone is mediated through the release of several vasoactive substances; therefore, a reduced response to endothelium-dependent agents does not identify which of the factors released by the endothelium is involved in this abnormality.
METHODS AND RESULTS: To investigate the role of
nitric oxide in the endothelium-dependent vasodilation in
hypercholesterolemia, we studied the effect of
NG-monomethyl-L-arginine (
L-NMMA), an inhibitor of endothelial
nitric oxide synthesis, on basal vascular tone and on the responses to
acetylcholine, an endothelium-dependent
vasodilator, and to
sodium nitroprusside, a direct smooth muscle dilator. The study included 33 hypercholesterolemic patients (17 men; 51 +/- 8 years; plasma
cholesterol, > or = 240 mg/dL) and 23 normal controls (12 men; 48 +/- 7 years; plasma
cholesterol, < 210 mg/dL). Drugs were infused into the brachial artery, and the response of the forearm vasculature was measured by strain-gauge plethysmography. Basal blood flow and vascular resistance were similar in hypercholesterolemic patients and normal controls (3.1 +/- 1 versus 2.6 +/- 0.8 mL/min per 100 mL and 32.1 +/- 13 versus 36.1 +/- 12 mm Hg/mL-1.min-1.100 mL-1, respectively). The reduction in basal blood flow and increase in vascular resistance produced by
L-NMMA were not significantly different between the two groups.
L-NMMA markedly blunted the response to
acetylcholine in normals (maximum flow decreased from 16.4 +/- 8 to 7.0 +/- 3; P < .005); however, the
arginine analogue did not significantly modify the response to
acetylcholine in the hypercholesterolemic patients (maximum flow, 11.1 +/- 8 versus 10.0 +/- 8).
L-NMMA did not modify the
vasodilator response to
sodium nitroprusside in either controls or patients.
CONCLUSIONS: