The association of endothelial dysfunction and cardiovascular events in healthy subjects and patients with cardiovascular disease.
BACKGROUND
Endothelial dysfunction is recognized as a major factor in the development of atherosclerosis and it has a prognostic value.


OBJECTIVE
To detect the long-term association of peripheral vascular endothelial function and clinical outcome in healthy subjects and patients with cardiovascular disease.


METHODS
We prospectively assessed brachial artery flow-mediated dilatation in 110 consecutive subjects (46 CVD patients and 64 healthy controls), mean age 57 +/- 11 years; 68 were men. After an overnight fast and discontinuation of all medications for > or = 12 hours, percent improvement in FMD and nitroglycerin-mediated vasodilatation were assessed using high resolution ultrasound.


RESULTS
%FMD but not %NTG was significantly lower in CVD patients (9.5 +/- 8.0% vs. 13.5 +/- 8.0%, P = 0.012) compared to healthy controls (13.4 +/- 8.0% vs. 16.7 +/- 11.0%, P = 0.084; respectively). In addition, an inverse correlation between %FMD and the number of traditional CVD risk factors was found among all study participants (r = -0.23, P = 0.015) and healthy controls (r = -0.23, P = 0.036). In a mean follow-up of 15 +/- 2 months, the composite CVD endpoints (all-cause mortality, myocardial infarction, hospitalization for heart failure or angina pectoris, stroke, coronary artery bypass grafting and percutaneous coronary interventions) were significantly more common in subjects with FMD < 6% compared to subjects with FMD > 6% (33.3% vs. 12.1%, P < 0.03, respectively).


CONCLUSIONS
Thus, brachial artery %FMD provides important prognostic information in addition to that derived from traditional risk factor assessment.
Shechter
Michael
M
Heart Institute, Sheba Medical Center, Tel Hashomer, Israel. shechtes@netvision.net.il
Marai
Ibrahim
I
Marai
Saed
S
Sherer
Yaniv
Y
Sela
Ben-Ami
BA
Feinberg
Micha S
MS
Rubinstein
Ardon
A
Shoenfeld
Yehuda
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D004562:Electrocardiography; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D018617:Ultrasonography, Doppler, Pulsed; D014664:Vasodilation / Q000187:drug effects / Q000502:physiology*; D014665:Vasodilator Agents
D014665:Vasodilator Agents; D005996:Nitroglycerin