Association of endothelial function and vascular data with LDL-c and HDL-c in a homogeneous population of middle-aged, healthy military men: Evidence for a critical role of optimal lipid levels

Background: Modifying lipids levels underpins atherosclerosis prevention. Flow-mediated dilation (FMD) could advise which patients to treat and to what extent. Little is known about the influence of near-normal lipid levels on the endothelium and the mechanisms related to different lipid fractions. We studied associations between FMD and lipids, focusing on normal lipid levels. Methods: An age-homogeneous sample of 171 healthy, untreated military men (mean age 35.5 ± 1.1 years) was studied: serum lipid determination and brachial artery ultrasound with a forearm ischemia cuff and automated measurement were performed. NCEP-ATP III groups were used. Results: Significantly smaller vessel diameters were found among individuals with high HDL-c (4.10 mm vs. 4.24 mm), optimal LDL-c (4.00 mm vs. 4.22 mm), and normal triglycerides (< 150 mg/dl) (4.15 mm vs. 4.31 mm). Basal diameter correlated significantly with HDL-c and triglycerides. There were significant differences in FMD between low HDL-c compared to the rest (4.13% vs. 5.07%) and between optimal and near-optimal LDL-c compared to the rest (5.28% vs. 4.56%). HDL-c and LDL-c correlated with FMD. The inverse relation of high LDL-c and FMD is partially due to a decreased stimulus. Besides, stimulus heterogeneity may mask HDL-c link with FMD. Conclusion: Those subjects naturally (not pharmacologically) in the healthy tail-end of the lipid distributions have the best endothelial function and smaller vessels. Functional vascular remodeling might precede anatomical remodeling and, in early stages, vessel size should be considered a risk indicator rather than an atherosclerotic sign. Furthermore, controlling the stimulus seems necessary for detecting the relationship between HDL-c and FMD, and should be performed regularly.