title: Coronary endothelial dysfunction is associated with an increased risk of cerebrovascular events.
abstract: BACKGROUND
  Stroke, mainly attributable to atherothrombotic disease, represents a leading cause of disability and death in the Western world. Endothelial dysfunction, which is considered a key factor in atherogenesis, is associated with an increased risk of cardiovascular events. However, the magnitude of the association between coronary endothelial dysfunction (CED) and cerebrovascular events is unknown. This study was performed to investigate the association between CED and cerebrovascular events.
  
  
  RESULTS
  We studied 503 patients without obstructive coronary artery disease (CAD) who underwent coronary endothelial function testing by intracoronary acetylcholine infusion. Patients were divided according to the presence (n=305) or absence (n=198) of CED, and medical records were examined for the occurrence of ischemic or hemorrhagic stroke or transient ischemic attack either before (prevalent) or after (incident) coronary endothelial function testing. Among the study population, a total of 25 cerebrovascular events were documented, 22 in patients with CED (15 prevalent) and 3 in patients without (all prevalent) (P=0.008). Multivariable logistic regression, which included traditional cerebrovascular disease-related risk factors, identified the presence of CED as the single strongest factor associated with cerebrovascular events (OR, 4.32; 95% CI, 1.26 to 14.83). Kaplan-Meier analysis indicated that patients with CED had a significantly higher cumulative cerebrovascular event rate than those without (P=0.04).
  
  
  CONCLUSIONS
  Presence of CED in patients without obstructive CAD is independently associated with an increased risk of cerebrovascular events. Thus, detection of this early stage of atherosclerosis may provide important information to identify patients who benefit from aggressive preventive strategies.
authors.affiliation: Division of Community Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn 55905, USA.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Targonski
authors.forename: Piero O
authors.initials: PO
authors.lastname: Bonetti
authors.forename: Geralyn M
authors.initials: GM
authors.lastname: Pumper
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Higano
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Amir
authors.initials: A
authors.lastname: Lerman
mesh_terms: D000109:Acetylcholine; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology*; D004305:Dose-Response Relationship, Drug; D004730:Endothelium, Vascular / Q000737:chemistry* / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007261:Infusions, Intra-Arterial; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*
chemical_list: D000109:Acetylcholine