[Endothelial function in high risk cardiovascular patients].
BACKGROUND
Endothelial dysfunction is caused by risk factors, which have basic, and initial role in atherogenesis. During further progression it is still not known, whether is and how is endothelial dysfunction influenced by risk factors in the late phase of atherosclerosis and/or what kind of other factors play role in endothelial dysfunction.


OBJECTIVE
Brachial artery flow mediated vasodilation was examined in 293 high risk patients (vascular 2. type diabetes patients/persons with + 2 risk factors). Relationship between endothelial function and risk factors, and risk stratifications were statistically examined to define the principal predictors of endothelial dysfunction.


METHODS
1. Examination of flow mediated vasodilation of brachial artery with ultrasound machine, 2. Risk factors evaluating, 3. Vascular examinations: physical, exercise test, Holter monitoring, CW Doppler, duplex scan 4. Risk stratification (10 year risk of fatal vascular events), 5. Statistical analysis (comparative and cohort).


RESULTS
1. Mean endothelial function of 293 high risk patients was reduced (105.1%). 2. Vascular disease plays principal role of the endothelial function in late phase atherosclerosis, because significantly decreases the brachial artery vasodilation (104.3% v. 108.3% p < 0.01) and significantly more (p < 0.0009) endothelial dysfunction can be found in patients with vascular disease than without. 3. Bad risk stratification plays principal role too, because there are significantly (p = 0.012) more endothelial dysfunction in high risk patients, than with better risk stratification. 4. Lipid-, glucose-metabolic alterations, hypertension, age and smoking (all: p = NS) have not already any role in endothelial dysfunction in late phase atherosclerosis.


CONCLUSIONS
Role of risk factors in initial atherogenesis is scientific evidence, but the role of these factors can not be proved later, when endothelial dysfunction already evolved. In this phase of atherosclerosis the vascular disease and the bed risk stratification have principal role, because they can cause significant more reduction of already reduced endothelial function. Further studies necessary to determine, whether this statistically proved relationship have, or have not any clinical relevance.
Káli
András
A
Szent János Kórház, III. Belosztály, Budapest.
Jánosi
András
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001916:Brachial Artery; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D015716:Electrocardiography, Ambulatory; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D018608:Ultrasonography, Doppler; D014664:Vasodilation
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL