title: The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort.
abstract: BACKGROUND
  Brachial artery flow-mediated dilation (FMD) may predict cardiovascular events in selected high-risk patients. Whether FMD testing predicts cardiovascular events in asymptomatic, lower risk individuals from the general population is unknown.
  
  
  RESULTS
  As a part of a multi-ethnic, prospective cohort study, the Northern Manhattan Study, we examined FMD by high-resolution ultrasonography in 842 community participants who were free of stroke or myocardial infarction. Lower FMD levels predicted cardiovascular events (myocardial infarction, stroke and vascular death) at 36 months of follow-up (hazard ratio (HR)=1.12 for every 1% decrease in FMD, 95% CI 1.01-1.25, p=0.03). The risk of events in patients with FMD in the lower two tertiles (FMD<7.5%) was significantly higher than those in the highest tertile (HR=3.28, 95% CI 1.07-10.06, p=0.04 for lowest versus highest tertile, and HR=3.05, 95% CI 1.03-9.66, p=0.04 for middle versus highest tertile). In a multivariate analysis including cardiovascular risk factors, the increase in risk associated with FMD was no longer statistically significant.
  
  
  CONCLUSIONS
  Non-invasive FMD testing predicts incident cardiovascular events in this multi-ethnic, population-based sample, but its predictive value is not independent of cardiovascular risk factors.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY, United States.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.forename: Cairistine
authors.initials: C
authors.lastname: Grahame-Clarke
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Miyake
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez
authors.forename: Robert
authors.initials: R
authors.lastname: Sciacca
authors.forename: Marco
authors.initials: M
authors.lastname: Di Tullio
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.forename: Ralph
authors.initials: R
authors.lastname: Sacco
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
mesh_terms: D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D015331:Cohort Studies; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality*; D009519:New York City / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*; D014463:Ultrasonography