The Effects Of Load Trimetazidine On Endothelial Function Of Coronary Heart Disease Combined Hyperlipidemia

Objective: Coronary heart disease is one of the major diseases in humans harmful to human health and life . Constitute of a cause of death accounted for more than the first. Endothelial dysfunction can lead to coronary vascular tone control mechanism may be damaged and start the process of atherosclerosis. In recent years, studies have found that vascular endothelium is not a simple blood vessel, but is the organ of endocrine , metabolic and selective barrier function. Once the injured endothelium is injured, it may lead to platelet aggregation and the formation of thrombosis, it is the early performance in coronary atherosclerosis process. Many factors can cause endothelial dysfunction .The Hyperlipidemia caused by impaired vascular endothelial function is the starting atherogenic factors. Hyperlipidemia patients had already existed atherosclerotic plaques in the arteries before vascular endothelium dysfunction, endothelium-dependent vasodilatation dysfunction is the main performance, suppressed vasodilator responses include not only the aorta, but also resistance vascular. Dyslipidemia closely related to endothelial function dysfunction, even without the presence of AS, but also showed endothelial dysfunction. There is a close relationship between Coronary heart disease, endothelial dysfunction, and hyperlipidemia. Select one not only can improve endothelial cell function but also anti-ischemic drugs that as an effective way of treating coronary heart disease. Trimetazidine (trimetazidine TMZ) - long-chain 3 - keto acyl coenzyme A thiolase (3-KAT) inhibitors, besides improve myocardial cell metabolism and can also activate nitric oxide synthase indirectly therefore mediate vascular relaxing factor generation which means improvement of endothelial function.Its role in improving myocardial ischemia has been confirmed and widely used in clinical, but its role in improving endothelial function, has not been adequate research, the report very few. This study was designed by observing the load trimetazidine (Vasorel, Wan Shuang Li, made by the French pharmaceutical firm Servier) 60mg after two hour, the level of nitric oxide (NO) and the change of endothelium-dependent vasodilatation (FMD)of brachial artery to study the effects of load trimetazidine on endothelial function of coronary heart disease combined hyperlipidemia .Methods: 60 excepted for a history of hypertension and diabetes patients with coronary heart disease combined hyperlipidemia were enrolled in this study (47 male, 13 female, aged 30-75, average 51.32±8.36). Selected patients with coronary heart disease confirmed by coronary angiography (The diameter of law based on internationally accepted assessment of coronary artery stenosis, the diameter≥50% stenosis were defined as CHD, and the diameter<50% stenosis were defined as NCHD). The fasting blood lipids and fasting blood glucose (except for diabetes mellitus) were detected on the second day after admission to determine the patient suffering from hyperlipidemia(Total cholesterol of more than 5.72mmol / L). NO were detected on the third day after admission in the case of patients in stable condition, and immediately to the brachial artery ultrasound baseline brachial artery diameter, under the basis of the value of D0, and then to the brachial artery pressure, detection of reactive hyperemia brachial artery diameter D1, and calculate endothelium-dependent vasodilatation(FMD) of brachial artery , then immediately given load trimetazidine 60mg, after two hours detected NO levels, and once again made the brachial artery ultrasound to detected FMD.Results:1. Load trimetazidine 60mg after 2 hours,the plasma NO level was significantly higher than before treatment (46.01±6.74 vs 43.86±7.08umol/L, P<0.05).2. FMD% increased than before treatment (10.65±2.83 vs 9.89±2.27%, P<0.05).Conclusion:1. Loading dose of trimetazidine 60mg after two hours, the NO level was significantly higher than that before treatment, indicating loading dose of trimetazidine has improvement on endothelial function .2. Brachial artery endothelium-dependent vasodilation (FMD) was significantly higher than that before treatment, clarifying the load of trimetazidine has improved on endothelial function.3. No adverse reaction related to trimetazidine was found.