Thrombosis Research 97 (2000) 519–523 MINI-REPORT Plasma Concentrations of von Willebrand Factor in Patients with Angina Pectoris Secondary to Coronary Atherosclerosis or Cardiac Syndrome X Hans Erik Bøtker 1 and Jørgen Ingerslev 2 Departments of 1 Cardiology and 2 Clinical Immunology, Centre for Haemophilia and Thrombosis, Skejby Hospital, University Hospital Aarhus, DK-8200 Aarhus N, Denmark. (Received 11 June 1999 by Editor S. Schulman; revised/accepted 12 October 1999) circulation [2] and flow-mediated vasodilation dur- Key Words: Endothelium; Microcirculation; Microvascu- ing reactive hyperemia in the systemic circulation lar angina [4,6]. Cellular constituents may be released from damaged endothelial cells. Thus, endothelial func- T he term “cardiac syndrome X” is used for tion can also be assessed by measurement of circu- the clinical entity in patients suffering from lating markers of endothelial injury. The von Wille- angina pectoris and exercise-induced ST- brand factor (vWF) is an endothelial-derived segment depressions suggestive of myocardial isch- glycoprotein that is involved in primary hemostasis emia despite a normal coronary angiogram [1]. as well as in thrombogenesis and atherosclerotic Some of these patients have impaired endothe- vascular disease. Elevated plasma concentrations lium-dependent vasodilation of the coronary resis- of vWF is a measure of endothelial dysfunction tance vessels, which is thought to contribute to a [8,9]. In the present study, we compared circulating reduced vasodilator capacity [2,3]. An attenuated levels of vWF in patients with angina pectoris sec- hyperemic response to transient forearm ischemia ondary to syndrome X to those with documented suggests that the vascular involvement is not re- coronary atherosclerosis and in healthy control stricted to the coronary circulation [1,4]. Despite subjects. a high prevalence of generalized disturbances of vasomotor regulation, we have not found evidence for either systemic or coronary endothelial dys- 1. Subjects and Methods function in patients with syndrome X [4,5]. How- ever, it has recently been reported that endothelial The study was approved by the local Ethics Com- dysfunction involves peripheral conduit arteries in mittee. We studied 20 patients with syndrome X, patients with syndrome X to the same extent as in 20 patients with classic coronary artery disease patients with documented atherosclerotic coronary (CAD), and 20 healthy control subjects matched disease [6,7]. Thus far, endothelial function has for age, sex, blood pressure, body mass index, and been assessed using acetylcholine in the coronary smoking habits. All patients were in good general health without any associated disease. Patients with a recent myocardial infarction (6 months), his- Abbreviations: vWf, von Willebrand factor; CAD, coronary ar- tery disease. tory of coronary bypass surgery or angioplasty, or Corresponding author: Hans Erik Bøtker, Department of Cardiol- those treated with lipid-lowering drugs were not ogy, Skejby Hospital/University Hospital Aarhus, Brendstrup- included. Two cardiologists who were blinded to gaardsvej, DK-8200 Aarhus N, Denmark. Tel: +45 (8949) 6234; Fax: +45 (8949) 6009; E-mail: heb@dadlnet.dk. the results of the blood samples examined the coro- 0049-3848/00 $–see front matter  2000 Elsevier Science Ltd. All rights reserved. PII S0049-3848(99)00205-4