Pearls of Wisdom: Improving Endothelial Function
Robert is a 62-year-old man with a 10-year history of type 2 diabetes, hypertension, and dyslipidemia. Despite his coronary risk factors, Robert is reluctant to begin exercising.
Which of the following interventions has been shown to improve endothelial function in persons with coronary artery disease risk factors?
A. Magnesium Supplementation
B. Thermal treatment (sauna)
C. Ginseng tea
D. Inversion boots (upside-down suspension)
What is the correct answer?
(Answer and discussion on next page)
Louis Kuritzky, MD, has been involved in medical education since the 1970s. Drawing upon years of clinical experience, he has crafted each year for almost 3 decades a collection of items that are often underappreciated by clinicians, yet important for patients. His “Pearls of Wisdom” as we like to call them, have been shared with primary care physicians annually in an educational presentation entitled 5TIWIKLY (“5 Things I Wish I Knew Last Year”…. or the grammatically correct, “5 Things I Wish I’d Known Last Year”).
Now, for the first time, Dr Kuritzky is sharing with the Consultant360 audience. Sign up today to receive new advice each week.
Answer: Thermal treatment (sauna)
There are some patients, even those with high blood pressure and cholesterol, who refuse to exercise. In these patients, how might we improve the function of the endothelium?
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Endothelial Function
The endothelium is the innermost lining all of our vasculature, and is responsible for producing vasodilatory and vasoconstrictive substances such as nitric oxide and endothelin.
In patients with high blood pressure, high cholesterol, and those that smoke cigarettes, the endothelium is impaired and does not produce enough nitric oxide to induce arterial and/or venous dilation.
Endothelial function can be improved with physical activity, but are there methods effective in patients who refuse exercise?
The Research
In a study of 73 Japanese men with and without risk factors for coronary disease (hypertension, cholesterol, smoking), researchers examined the effects of spending 15 minutes within a dry sauna heated to 140 degrees Fahrenheit every day for 2 weeks.
Participants’ endothelial function was measured before and after the 2 weeks of sauna therapy using endothelium-dependent dilation (FMD) to quantify degree of endothelial function.
The Results
Before sauna therapy, the average FMD of patients without coronary risk factors was nearly twice as high as those with risk factors (8.2% vs 4%), indicative of endothelial dysfunction. After sauna therapy, the average FMD of patients with coronary risk factors rose from 4% to 5.8%. , whereas persons with healthy endothelial function experienced no change.
Thermal Rx to Improve Endothelial Function
What’s the “Take-Home?”
Some patients with coronary risk factors may be unconvinced of the necessity for exercise, counting on the fact that since they do not have manifest cardiovascular disease endpoints, they are not—in the traditional sense—"sick." Using FMD, we can see that even in these patients who only have cardiovascular disease risk factors, circulation may already be impaired. These data suggest that in patients who would benefit from improvement in endothelial function but refuse exercise, daily time spent in a dry sauna can effectively improve FMD.
Reference:
- Imamura M, Biro S, Kihara T, et al. Repeated thermal therapy improves impaired vascular endothelial function in patients with coronary risk factors. Journal of the American College of Cardiology. 2001;38(4):1083-1088