P290 Intensive 1-year lifestyle modification improves microvascular endothelial function in CAD patients.
1N.T.M.Knoblauch, 1A.Michalsen, 2T.Philipp, 1G.J.Dobos, 2R.R.Wenzel
1Dept. of Internal and Integrative Medicine, Kliniken Essen-Mitte, Essen; 2Dept. of Nephrology & Hypertension, University Hospital, Essen.

Background: In patients with coronary artery disease (CAD) endothelial function is impaired and correlates with morbidity and mortality. We examined the effect of an intensive lifestyle modification program over one year on endothelial function in CAD patients.

Methods and Results: We investigated the effects of acetylcholine (ACh 10-9-10-7 mol) induced vasodilatation as well as the effects of NO-synthase inhibitor L-NMMA (10-8 mol) vasoconstriction in the forearm skin microcirculation of 17 CAD patients and 12 healthy volunteers, using the double injection technique and laser Doppler imaging. The results are expressed in perfusion units (PU) as differences from saline in mean ± S.E.M.; the area under the time-response-curve was calculated (AUC). Measurements were performed at baseline and after one year of intensive lifestyle modification. Vasodilatation to ACh (10-9-10-7 mol) was significantly reduced in CAD patients compared to healthy volunteers (p<0.001). After one year of intensive lifestyle modification CAD patients showed a significant improvement of vasodilatation to ACh (p<0.001 versus baseline). L-NMMA (10-8 mol) induced a significant vasoconstriction, which was significantly reduced after one year of intensive lifestyle modification (-413 ± 92 AUC PU at baseline, -155 ± 95 AUC PU after 1 year of lifestyle modification; p<0.05).


Effects of acetylcholine (ACh 10-9-10-7 mol) induced vasodilatation in the hum Conclusions: These data demonstrate for the first time an improvement of endothelial function in CAD patients after one year of intensive lifestyle modification in the skin microcirculation. Laser Doppler imaging is a new method to assess the effects of cardiovascular intervention on endothelial function.