The predictive role of endothelial glycocalyx in primary prevention of cardiovascular events:a 6 year follow-up study

Abstract

Abstract Introduction Endothelial glycocalyx is a layer of glycoproteins on endothelial cells preventing vascular wall permeability to circulating proteins and blood cells. Perfused Boundary Region (PBR) of arterial microvessel is a non-invasive marker of endothelial glycocalyx thickness, as increased PBR indicates a reduced endothelial glycocalyx thickness. Cardiovasular risk factors and cardiovascular diseases have been associated with impaired PBR. However, PBR has not been studied as a predictor of major adverse cardiovascular events (MACE) in primary prevention. Methods We studied 400 adults, without history cardiovascular disease. We measured PBR of sublingual vessels with diameter 5–25μm by GlycoCheck Software using a dedicated camera (Sidefield Darkview Imaging, Microscan MV, Nederlands). We recorded a full medical history for each subject. The participants were followed up for a period of 6 years for major cardiovascular events (including Acute Coronary Syndrome, Stroke, decompensated acute heart failure, cardiovascular death and death of all causes). Results The mean age of participants was 49±10 years, 52% were males, 65% active smokers, 33.3% had hyperlipidemia, 12.8% type 2 Diabetes respectively, 30% hypertension and 20.5% had positive family history of premature coronary artery disease. The median PBR value was equal to 1.15 μm. After 6 years of follow up, 42 MACE were recorded (7 cardiovascular deaths). In univariate analysis, subjects with PBR values >1.15μm had greater risk of adverse events compared with those that had lower PBR (relative risk RR=2.83, p<0.05). Diabetes and hypertension were also univariate predictors of MACE (RR=3.71 and RR=2.51, p<0.05). In multivariate analysis after adjusting for atherosclerotic risk factors including diabetes and hypertension, PBR remained a an independent predictor of MACE (RR=2.67, p<0.05) Conclusion Endothelial glycocalyx thickness appears to be an important independent predictor of adverse cardiovascular outcomes. Predictive value endothelial glycocalyx Funding Acknowledgement Type of funding source: None