title: Large brachial artery diameter is associated with angiographic coronary artery disease in women.
abstract: BACKGROUND
  Noninvasive methods are needed for the identification of women at highest risk for coronary artery disease (CAD) who might benefit most from aggressive preventive therapy. Identification of brachial artery atherosclerosis, which correlates with coronary artery atherosclerosis, may be useful to estimate or stratify CAD risk. Because atherosclerosis disrupts the arterial architecture that regulates vessel size, we hypothesized that noninvasively measured large brachial artery diameter is a manifestation of atherosclerosis that is associated with angiographic CAD in women with chest pain.
  
  
  METHODS
  We examined 376 women (mean age, 57.1 years) with chest pain in the National Heart, Lung, and Blood Institute's Women's Ischemia Syndrome Evaluation study who underwent B-mode ultrasound scan measurement of brachial artery diameter at rest and during hyperemic stress (to quantify flow-mediated dilation), quantitative coronary angiography, and risk factor assessment.
  
  
  RESULTS
  Large resting brachial artery diameter was associated with significant angiographic CAD (3.90 +/- 0.79 mm vs 3.52 +/- 0.59 mm in women with CAD vs no CAD; P <.001). Impaired flow-mediated dilation, which correlated with resting diameter (r = -0.17; P =.001), was weakly associated with significant CAD (2.74% +/- 7.11% vs 4.48% +/- 9.52% in CAD vs no CAD; P =.046). After adjustment for age, body size, and CAD risk factors, women with large resting brachial artery diameters (>4.1 mm) had 3.6-fold increased odds (95% confidence interval, 1.8 to 7.1; P <.001) of significant angiographic CAD compared with those with small brachial arteries (</=3.6 mm).
  
  
  CONCLUSIONS
  Large resting brachial artery diameter is an independent predictor of significant CAD in women with chest pain. Therefore, a simple ultrasonographic technique may be useful in the identification of women with chest pain who are at increased risk for CAD.
authors.affiliation: Department of Epidemiology and the Cardiovascular Institute, University of Pittsburgh, PA 15213, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: Richard H
authors.initials: RH
authors.lastname: Karas
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Pepine
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Rickens
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Reichek
authors.forename: William J
authors.initials: WJ
authors.lastname: Rogers
authors.forename: Barry L
authors.initials: BL
authors.lastname: Sharaf
authors.forename: George
authors.initials: G
authors.lastname: Sopko
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Susan P
authors.initials: SP
authors.lastname: McGorray
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000473:pathology; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D002637:Chest Pain; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012039:Regional Blood Flow; D014463:Ultrasonography