title: Endothelial function in resistance and conduit arteries and 5-year risk of cardiovascular disease.
abstract: BACKGROUND
  Impaired endothelial function has been implicated as a cause of cardiovascular disease. Little is known of the relations of measures of endothelial function in resistance and conduit arteries to incident cardiovascular disease in the general population, and available techniques have not been compared.
  
  
  RESULTS
  In 1016 participants (70 years of age) of the population-based Prospective Study of the Vasculature in Uppsala Seniors (PIVUS) study (52% women), we measured endothelium-dependent vasodilation using the invasive forearm technique with acetylcholine given in the brachial artery, the brachial artery ultrasound technique with measurement of flow-mediated dilatation, and the pulse-wave analysis-based method with β-2-agonist terbutaline provocation. During 5 years of follow-up, 101 participants experienced a composite end point of myocardial infarction, stroke, or death, excluding the 85 persons with a history of myocardial infarction or stroke at baseline. In logistic regression models adjusted for several established and novel cardiovascular disease risk factors and medications, endothelium-dependent vasodilation by the invasive forearm technique with acetylcholine was associated with risk of the end point (odds ratio, 0.72 per SD; 95% confidence interval, 0.56 to 0.93; P=0.01). Endothelial function by the other 2 methods was not related to risk of the end point. Addition of endothelium-dependent vasodilation to the Framingham risk score improved discrimination of risk of the end point.
  
  
  CONCLUSIONS
  Endothelium-dependent vasodilation in resistance arteries, but not in the brachial conduit artery (flow-mediated dilatation), was associated with 5-year risk of a composite end point of death, myocardial infarction, or stroke independently of major cardiovascular disease risk factors. This vascular measurement improved risk discrimination when added to an established risk score in an elderly population.
authors: Department of Medical Sciences, Uppsala University Hospital, SE-751 85 Uppsala, Sweden. lars.lind@medsci.uu.se
authors: Lars
authors: L
authors: Lind
authors: Lars
authors: L
authors: Berglund
authors: Anders
authors: A
authors: Larsson
authors: Johan
authors: J
authors: Sundström
mesh_terms: D000368:Aged; D001158:Arteries / Q000502:physiology*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000098:blood supply; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology; D013548:Sweden; D014463:Ultrasonography; D014655:Vascular Resistance / Q000502:physiology*; D014664:Vasodilation / Q000502:physiology