Atherosclerosis in patients with cyanotic congenital heart disease

Abstract

Background: Cyanotic patients with congenital heart disease (CHD) might be protected against atherosclerosis. Methods and Results: Atherosclerotic risk factors and carotid intima-media thickness (IMT) were investigated in adults with cyanotic CHD and in unaffected age-and sex-matched controls. Fifty-four cyanotic patients (30 men, mean age 38, range 19-60 years) and 54 controls were included. Mean transcutaneous saturation of the cyanotic patients was 81±6%. Mean carotid IMT adjusted for age was significantly decreased in cyanotic patients compared to controls (0.55±0.1 mm vs 0.58±0.08 mm: ΔIMT =0.04 mm [SE 0.015], P=0.01). In cyanotic patients lower total cholesterol levels were observed (4.4±1 mmol/L vs 4.9±1 mmol/L; P=0.02), as well as lower thrombocyte levels (173±81×109 /L vs 255±54×109 /L; P<0.01), higher bilirubin levels (18.6±11 μmol/L vs 12.7±6μmol/L; P<0.01), and lower diastolic and systolic blood pressure (71±9 mmHg vs 76±9 mmHg, P<0.01; 113±14 mmHg vs 124±12 mmHg, P<0.01, respectively). Conclusions: In patients with cyanotic CHD carotid IMT, and hence atherosclerosis disease risk, was decreased. This might be due to a combination of reduced atherosclerotic risk factors such as lower blood pressure, lower total cholesterol levels, higher bilirubin levels and lower thrombocyte levels.