Abstract
BackgroundIndian Asians are at increased risk of cardiovascular death which does not appear to be explained by conventional risk factors. As microvascular disease is also more prevalent in Indian Asians, and as it is thought to play a role in the development of macrovascular disease, we decided to determine whether impaired microcirculation could contribute to this increased cardiovascular risk in Indian Asians.MethodsForearm skin laser Doppler fluximetry in response to heating and ischaemia was assessed in 83 Europeans (41 with angiographically confirmed atherosclerotic coronary artery disease (CAD) and 42 from the general population) and 84 Indian Asians (41 with CAD). Explanations for differences in microvascular function were sought using multivariate analysis including conventional cardiovascular risk factors.ResultsCompared to ethnically matched control populations both Europeans and Indian Asians with CAD had poorer microvascular responses to heating than those without (117(95% CI 105-131) vs. 142(130-162) arbitrary units, (au) for Europeans and 111(101-122) vs. 141(131-153)au for Indian Asians) and to ischaemia (44(38-50) vs. 57(49-67)au & 39(34-45) vs. 49(43-56)au respectively). These differences were not accounted for by conventional cardiovascular risk factors. There was no ethnic difference in the attenuation of microvascular function associated with CAD.ConclusionPatients of European and Indian Asian descent with symptomatic CAD have poorer microvascular maximal tissue perfusion and reactive hyperaemia in the skin compared to ethnically matched asymptomatic control populations. Despite the increased cardiovascular risk in Indian Asians, the attenuation of microvascular function associated with CAD was equivalent in the ethic groups. This suggests that in Indian Asians microcirculation does not explain the increased susceptibility to CAD.
Highlights
Indian Asians are at increased risk of cardiovascular death which does not appear to be explained by conventional risk factors
Otherwise there were no ethnic differences in microvascular function in either maximum hyperaemia or reactive hyperaemia
We have demonstrated that patients presenting to cardiac services with symptomatic atherosclerotic coronary artery disease have systemic microvascular dysfunction detectable in the skin, independent of conventional cardiac risk factors
Summary
Indian Asians are at increased risk of cardiovascular death which does not appear to be explained by conventional risk factors. People of Indian Asian descent are at increased risk of cardiovascular disease[1,2] This is only partly explained by the increased prevalence and susceptibility to insulin resistance and associated central obesity, hyperglycaemia and dyslipidaemia[3]. These risk factors are predictors of microvascular dysfunction[4], which may account for the increased incidence of microvascular target organ damage reported in people of South Asian decent including microalbuminuria [5,6], diabetic retinopathy [7] and nephropathy [8]. Skin vessels are an accessible location to explore the microvasculature They can be investigated non-invasively in large patient cohorts and mirror disturbances in other vascular beds. Disturbances in skin microcirculatory reactive hyperaemia correlate positively with Framingham risk scores[12] in otherwise healthy volunteers
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