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Hypercholesterolemia, Lipid-Lowering Strategies and Microcirculation

  • Teresa PadróEmail author
  • Gemma Vilahur
  • Lina Badimon
Chapter

Abstract

Hypercholesterolemia is a major risk for cardiovascular disease mainly due to its contribution to the pathogenesis of atherosclerosis in medium-size and large arteries. In addition, accumulating evidence shows a link between the chronic and abnormal increase of cholesterol and adverse effects on the microcirculation, since early stages of atherosclerosis and before any angiographic evidence of epicardial coronary stenosis. Moreover, hypercholesterolemia by compromising microvascular function has been proved to lead to larger infarcts and adverse cardiac remodeling post-myocardial infarction. The diverse responses of the microvasculature to hypercholesterolemia include oxidative stress, impaired endothelial function, enhanced leukocyte- and platelet- endothelial cell adhesion and thrombosis. Over the past years, benefits of lipid-lowering therapies on coronary microcirculation have mostly focused on statins and patients undergoing cardiac intervention providing evidence that statins elicit beneficial effects on microvasculature integrity leading to better functional recovery after myocardial infarction. However, the association of the statin benefits with its lipid-lowering effect still needs to be clarified. This review article addresses existing evidence regarding microvascular alterations related to hypercholesterolemia, the mechanism by which high cholesterol levels induce functional changes in the microvascular bed and, finally comments on the impact of dyslipidemia-induced microvascular dysfunction at the myocardial level and the benefits of current lipid-lowering strategies.

Keywords

Low-density-lipoproteins Cholesterol Microvascular dysfunction Statins Apheresis Nitric oxide Inflammation Oxidative stress Endothelial cells 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Teresa Padró
    • 1
    • 2
    Email author
  • Gemma Vilahur
    • 1
    • 2
  • Lina Badimon
    • 1
    • 2
    • 3
  1. 1.Cardiovascular Program-ICCCResearch Institute Hospital de la Santa Creu i Sant Pau, IIB-Sant PauBarcelonaSpain
  2. 2.CIBERCV Instituto de Salud Carlos IIIBarcelonaSpain
  3. 3.UABBarcelonaSpain

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