title: The prevalence of endothelial dysfunction in patients with and without coronary artery disease.
abstract: BACKGROUND
  Endothelial dysfunction (ED) is frequently present in patients presenting with acute or stable coronary artery disease (CAD), but it is also found in patients presenting with chest pain without angiographic coronary lesions.
  
  
  OBJECTIVE
  We hypothesized that even in patients without CAD, the presence of cardiovascular (CV) risk factors will correlate with the presence of ED.
  
  
  METHODS
  Our study included a total of 341 consecutive patients referred for coronary angiography. We used pulse wave analysis with a finger plethysmograph (peripheral arterial tonometry) to determine endothelial function. Hyperemia ratio was calculated as the ratio of the postischemic hyperemia response relative to baseline measurement.
  
  
  RESULTS
  The hyperemia ratio was significantly higher in patients without CAD (2.02 ± 0.52) compared with patients with chronic CAD (1.81 ± 0.44, P = 0.001) or acute CAD (1.74 ± 0.49, P < 0.001). Prevalence of ED was 33%, 46%, and 58%, respectively. In multivariate analysis, the presence of CAD, diabetes, and cigarette smoking, and the total number of CV risk factors, were strong predictors of ED. In 67% of the patients without CAD but with ≥3 CV risk factors, ED was present.
  
  
  CONCLUSIONS
  Prevalence of ED in patients with chest pain depends on the presence of CAD and CV risk factors. Patients without CAD but with ≥3 risk factors frequently presented with ED. Such patients may be at increased risk for future CV events and may profit from intensified therapy to control CV risk factors.
authors.affiliation: Division of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Toggweiler
authors.forename: Andreas
authors.initials: A
authors.lastname: Schoenenberger
authors.forename: Nadja
authors.initials: N
authors.lastname: Urbanek
authors.forename: Paul
authors.initials: P
authors.lastname: Erne
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008365:Manometry; D008875:Middle Aged; D016017:Odds Ratio; D010991:Plethysmography; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland