Abstract
Endothelial dysfunction is a well-known component of the pathophysiology of heart failure (HF), with proven prognostic value. Dietary supplementation with whey protein (WP) has been widely used to increase skeletal muscle mass, but it also has vascular effects, which are less understood. This study aimed to evaluate the effects of WP supplementation on the systemic microvascular function of HF patients. This was a blinded, randomized, placebo-controlled clinical trial that evaluated the effects of 12-week WP dietary supplementation on systemic microvascular function, in patients with HF New York Heart Association (NYHA) classes I/II. Cutaneous microvascular flow and reactivity were assessed using laser speckle contrast imaging, coupled with pharmacological local vasodilator stimuli. Fifteen patients (aged 64.5±6.2 years, 11 males) received WP supplementation and ten patients (aged 68.2±8.8 years, 8 males) received placebo (maltodextrin). The increase in endothelial-dependent microvascular vasodilation, induced by skin iontophoresis of acetylcholine, was improved after WP (P=0.03) but not placebo (P=0.37) supplementation. Moreover, endothelial-independent microvascular vasodilation induced by skin iontophoresis of sodium nitroprusside, was also enhanced after WP (P=0.04) but not placebo (P=0.42) supplementation. The results suggested that dietary supplementation with WP improved systemic microvascular function in patients with HF.
Highlights
Dietary supplementation with whey protein (WP) is known to improve blood pressure, systemic vascular resistance and arterial stiffness in overweight and obese individuals [1,2].Endothelial dysfunction is a known component of the pathophysiology of heart failure (HF) [3,4] and has been reported to adversely affect the prognosis in several cardiovascular disorders [5]
It is important to note that macro- and microvascular dysfunctions are defined as the impairment of endotheliumdependent vasodilation and/or increased arterial stiffness, which are related to several cardiovascular diseases, including hypertension, atherosclerosis, diabetes, and heart failure [16]
Our results suggested that dietary supplementation with WP improved microvascular endothelial function and possibly smooth muscle structure in patients with HF
Summary
Dietary supplementation with whey protein (WP) is known to improve blood pressure, systemic vascular resistance and arterial stiffness in overweight and obese individuals [1,2].Endothelial dysfunction is a known component of the pathophysiology of heart failure (HF) [3,4] and has been reported to adversely affect the prognosis in several cardiovascular disorders [5]. Adult patients with heart failure, in New York Heart Association (NYHA) functional classes II–III, and with more severe endothelial dysfunction have a higher incidence of hospitalization due to decompensation of HF, cardiac transplantation, or cardiac death in a 1-year follow-up than those with relatively preserved endothelium-dependent relaxation [6]. Endothelial microvascular function may currently be evaluated using laser speckle contrast imaging (LSCI), coupled with skin micro-iontophoresis of acetylcholine (ACh) for the study of endothelial-dependent vasodilation, and sodium nitroprusside (SNP) for endothelium-independent vasodilation. This method allows measurements of microvascular blood flow with very good reproducibility [8] and has been employed to evaluate microvascular function in several contexts [9,10,11]
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