The endothelial glycocalyx in premature cardiovascular disease

Further improvement in cardiovascular disease management in high-risk
individuals calls for novel strategies to detect early atherosclerotic changes,
before overt cardiovascular disease exists. This would lead to the selection
and treatment of individuals at risk in an early phase. Family members of
subjects with premature cardiovascular disease are such a high risk group,
although it is still not possible to asses individual risk, apart from risk
factor scores. The endothelial glycocalyx, is a component of the vasculature
and has been associated with surrogate endpoints of early cardiovascular
disease. This inner layer of the vessel wall exerts potent anti-atherogenic
effects in vivo. To enlighten the protective role of the glycocalyx on the
vascular endothelium more knowledge is needed in several disease states. We
therefore, hypothesize that glycocalyx volume is diminished in subjects with
premature atherosclerosis and in part also in yet unidentified, seemingly
unaffected first degree relatives.

To investigate the relation between premature cardiovascular disease and
glycocalyx perturbation

Observational study

The nature of the burden consists of an approximately 12 hour fasting period
previous to a one hours visit to our clinical trial unit. The patients will
visit the hospital on one occasion. During this visit, the patients will be
asked to fill out a short questionnaire and undergo a short physical
examination. Furthermore, SDF measurement (non-invasive imaging of the
sublingual microcirculation), PWV measurement and venapuncture (blood
withdrawal of 11.5 ml) will be done. Patients will be asked to postpone
medication in take until after the test-visit and refrain from smoking 24 hours
before the start of the visit.

The benefit of this investigation lies in the fact that this method provides
the use of a unique technique to investigate early atherosclerotic vascular
changes. If our expectations are confirmed, this might renders us a tool which
will be able to identify seemingly unaffected subjects in an early stage at
risk for cardiovascular disease. The identification of these subjects makes it
possible to treat them early on in their disease and hopefully thereby prevent
overt atherosclerotic disease. Furthermore, this is the first large scale study
on human glycocalyx measurement, since we use a novel technique. Since the
systemic measurement of the glycocalyx, previously used, is rather invasive and
time consuming, this is not the ideal method to use on a large scale. Recently,
we were able to develop an accurate, non invasive technique, to measure
glycocalyx thickness, which enables us to investigate the glycocalyx in large
population samples.