The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort.
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.
Shimbo
Daichi
D
Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY, United States.
Grahame-Clarke
Cairistine
C
Miyake
Yumiko
Y
Rodriguez
Carlos
C
Sciacca
Robert
R
Di Tullio
Marco
M
Boden-Albala
Bernadette
B
Sacco
Ralph
R
Homma
Shunichi
S
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