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(Hypertension. 1998;31:1266-1271.)
© 1998 American Heart Association, Inc.

Scientific Contributions

Insulin-Mediated Venodilation Is Impaired in Patients With High Cholesterol

Bong Hee Sung; Marilou Ching; Joseph Izzo, Jr; Paresh Dandona; ; Michael F. Wilson

From the Department of Medicine, State University of New York, and Millard Fillmore Hospital, Buffalo, NY.

Correspondence to Bong Hee Sung, PhD, Department of Medicine, Millard Fillmore Hospital, 3 Gates Cir, Buffalo, NY 14209. E-mail bsung{at}MFHS.edu

Abstract—Recently we have reported that insulin attenuates norepinephrine (NE)-induced vasoconstriction via a cyclic GMP–NO synthase pathway. Because hypercholesterolemia has been associated with abnormal endothelial function, we investigated whether insulin-mediated vasodilation is impaired in hypercholesterolemia. To assess vasoreactivity, NE (12.5, 25, 50, and 100 ng/min), NE (100 ng/min) combined with insulin (8, 16, 24, and 32 µU/min), and NE (100 ng/min) combined with sodium nitroprusside (0.01, 0.1, 1, 10, and 100 ng/min) were infused into dorsal hand veins. Changes in venous diameter were measured by ultrasonography, using a 7.5-MHz transducer. Twenty-two healthy, normotensive hypercholesterolemic subjects (HC; mean total cholesterol 6.93 mmol/L, HDL 1.45 mmol/L, LDL 4.81 mmol/L) and 18 age-matched normal control subjects (NC; mean total cholesterol 4.81 mmol/L, HDL 1.16 mmol/L, LDL 3.18 mmol/L) were studied. All HC had normal glucose tolerance test results. Baseline vein diameters were similar between groups, and the vasoconstrictor response to NE was not significantly different between HC and NC. Insulin significantly attenuated NE-induced vasoconstriction in NC but not in HC (P<0.01). Both groups were able to venodilate with sodium nitroprusside. To investigate the effects of cholesterol reduction on vascular reactivity, venoreactivity studies were repeated in 12 HC after treatment with 20 to 40 mg/d lovastatin for 6 weeks. There were no significant venoreactivity changes with the treatment. Plasma LDL cholesterol concentration was inversely correlated to venodilator effect of insulin (r=-0.42, P<0.02). In conclusion, insulin-mediated vasodilation is impaired in patients with high cholesterol. Absence of normal insulin-mediated but not sodium nitroprusside–induced venodilation in hypercholesterolemia suggests that insulin-mediated vasodilation is endothelium dependent.

Key Words: hypercholesterolemia • vasoreactivity • insulin • norepinephrine • endothelium

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