Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

David G. Silverman

Subject Area(s)

Medicine

Abstract

Anesthesiologists' expertise in perioperative monitoring of cardiovascular physiology can be readily expanded to non-operative settings in an attempt to impact cardiovascular disease and its consequences. This has prompted our present assessment of the impact of a high-fat (HF) meal on endothelial function.

We concurrently employed a battery of tests to assess: 1) changes in endothelial function at the level of conduit blood vessels as measured by flow-mediated dilation (FMD) secondary to occlusion-induced endothelium-dependent nitric oxide release; 2) local changes in microvascular reactivity in response to transdermal nitroglycerin (NTG), a nitric oxide donor that induces endothelium-independent vasodilation; and 3) the combined effects of potential autonomic dysfunction and endothelial function at the site of transdermal nicotine (NIC), which activates postganglionic parasympathetic fibers which, in turn, release acetylcholine from an intact endothelium causing endothelium-dependent vasodilation.

With IRB approval, 14 healthy volunteers were studied, in a crossover design, after a HF meal (75 grams total fat) and an equi-caloric low-fat (LF) (<15 grams total fat) meal on separate days. On each day, subject underwent FMD, NTG and NIC.

While there was a trend towards decreased blood flow after HF meal, this was not significant. The average LF-HF difference in FMD was 1.84% ± 6.3 (p=NS). Responses to NTG and NIC were similar on both days.

In conclusion, we noted no significant impact on the microvasculature in healthy volunteers as a consequence of a fatty meal.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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