title: The research on endothelial function in women and men at risk for cardiovascular disease (REWARD) study: methodology.
abstract: BACKGROUND
  Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD) in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR) test (a proxy measure of endothelial function) for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1) endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2) endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men.
  
  
  METHODS
  A total of 1972 patients (812 men and 1160 women) undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events).
  
  
  CONCLUSIONS
  This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of risk stratification in women on par with that of men.
authors.affiliation: Montreal Behavioural Medicine Centre, Montreal, Canada. simon.bacon@concordia.ca
authors.forename: Simon L
authors.initials: SL
authors.lastname: Bacon
authors.forename: Kim L
authors.initials: KL
authors.lastname: Lavoie
authors.forename: André
authors.initials: A
authors.lastname: Arsenault
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Dupuis
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
authors.forename: Catherine
authors.initials: C
authors.lastname: Laurin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gordon
authors.forename: Denyse
authors.initials: D
authors.lastname: Gautrin
authors.forename: Alain
authors.initials: A
authors.lastname: Vadeboncoeur
mesh_terms: D000368:Aged; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000502:physiology; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D012727:Sex Characteristics; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods