title: Forearm hyperemia is a better marker than carotid intima-media thickness or ankle-brachial index for coronary artery disease in Japanese males under 65.
abstract: Forearm hyperemia, carotid intima-media thickness (IMT), and ankle-brachial pressure index (ABI) are subclinical markers associated with coronary artery disease (CAD). However, it is not known which marker is most highly correlated with CAD. We therefore compared these three parameters in the same patients under 65 years of age. In 40 males with documented CAD (mean age, 53 years), we measured forearm hyperemia by plethysmography, carotid IMT by B-mode ultrasound, and ABI by Doppler ultrasonography. Microalbuminuria, serum lipids, glucose and C-reactive protein (CRP) were also measured. Thirteen normal males served as controls (mean age, 49 years). Compared with normal subjects, CAD patients had lower hyperemia (42 vs. 92%; p < 0.001) and greater carotid IMT (0.81 vs. 0.67 mm; p < 0.01), but ABI was similar. The sensitivity of forearm hyperemia (72%) was higher than that of carotid IMT (22%) or ABI (3%) (abnormal criteria: forearm hyperemia < 60%, carotid IMT 21.0 mm, and ABI < 0.9). The patients had higher serum low-density lipoprotein (LDL) cholesterol, glucose and CRP, and lower high-density lipoprotein (HDL) cholesterol than the controls. Albuminuria was present in 49% of patients. Subclinical markers were further analyzed by age (35-54 vs. 55-64 years). The sensitivity of carotid IMT was lower in the younger patients (4% vs. 33%), while that of forearm hyperemia (69% vs. 75%) and albuminuria (47% vs. 52%) did not change with age. While carotid ultrasound was useful in older patients ( > or = 55 years), forearm hyperemia and microalbuminuria were sensitive markers irrespective of age. ABI was not useful in the Japanese men with CAD under age 65.
authors.affiliation: Third Department of Internal Medicine, Osaka Medical College, 2-7 Daigakumachi, Takatsuki 569-8686, Japan. tonari@sam.hi-ho.ne.jp
authors.forename: Satoko
authors.initials: S
authors.lastname: Tonari
authors.forename: Hikaru
authors.initials: H
authors.lastname: Nishimura
authors.forename: Kiyo
authors.initials: K
authors.lastname: Fukunishi
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Mori
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kitaura
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology / Q000503:physiopathology; D000842:Ankle / Q000098:blood supply; D015415:Biomarkers; D001916:Brachial Artery / Q000502:physiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology; D005542:Forearm / Q000098:blood supply; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis* / Q000453:epidemiology; D007564:Japan; D008297:Male; D008875:Middle Aged; D010991:Plethysmography / Q000592:standards; D015203:Reproducibility of Results; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology; D018608:Ultrasonography, Doppler / Q000592:standards
chemical_list: D015415:Biomarkers