title: Endothelial dysfunction is associated with carotid plaque: a cross-sectional study from the population based Northern Manhattan Study.
abstract: BACKGROUND
  Impaired vascular function occurs early in atherogenesis. Brachial flow mediated dilatation (FMD) is a non-invasive measure of vascular function and may be an important marker of preclinical atherosclerosis. Data on the association between FMD and carotid plaque in multi-ethnic populations are limited. The objective of this study was to determine whether endothelial dysfunction is independently associated with carotid plaque in a community of northern Manhattan.
  
  
  METHODS
  In the population-based Northern Manhattan Study (NOMAS), high-resolution B-mode ultrasound images of the brachial and carotid arteries were obtained in 643 stroke-free subjects (mean age 66 years; 55% women; 65% Caribbean-Hispanic, 17% African-American, 16% Caucasian). Brachial FMD was measured during reactive hyperemia. Maximum carotid plaque thickness (MCPT) was measured at the peak plaque prominence.
  
  
  RESULTS
  The mean brachial FMD was 5.78 +/- 3.83 %. Carotid plaque was present in 339 (53%) subjects. The mean MCPT was 1.68 +/- 0.82 mm, and the 75th percentile was 2.0 mm. Reduced FMD was significantly associated with increased MCPT. After adjusting for demographics, vascular risk factors, and education, each percent of FMD decrease was associated with a significant 0.02 mm increase in MCPT (p = 0.028). In a dichotomous adjusted model, blunted FMD was associated with an increased risk of MCPT > or = 2.0 mm (OR, 1.11 for every 1% decrease in FMD; 95% CI, 1.03-1.19).
  
  
  CONCLUSIONS
  Decreased brachial FMD is independently associated with carotid plaque. Non-invasive evaluation of endothelial dysfunction may be a useful marker of preclinical atherosclerosis and help to individualize cardiovascular risk assessment beyond traditional risk factors.
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, USA. tr89@columbia.edu
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Rameet
authors.initials: R
authors.lastname: Hundle
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ratchford
authors.forename: Romel
authors.initials: R
authors.lastname: Ramas
authors.forename: Robert
authors.initials: R
authors.lastname: Sciacca
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Bernadette
authors.initials: B
authors.lastname: Boden-Albala
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Miyake
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001916:Brachial Artery / Q000000981:diagnostic imaging*; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000208:ethnology / Q000473:pathology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D004108:Dilatation, Pathologic; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012039:Regional Blood Flow; D012307:Risk Factors; D014463:Ultrasonography; D044465:White People