title: Efficacy of combined use of three non-invasive atherosclerosis tests to predict vascular events in the elderly; carotid intima-media thickness, flow-mediated dilation of brachial artery and pulse wave velocity.
abstract: BACKGROUND
  Intima-media thickness (IMT) of the carotid artery, flow-mediated dilation (FMD) of the brachial artery, and pulse wave velocity of the central artery (PWV) have been widely used to evaluate progression of atherosclerosis. Our previous work has revealed that IMT, FMD and PWV are related to each other, and the combination of these measurements was useful in identifying patients with atherosclerotic disease. The aim of the present study was to investigate whether combination of these measurements would predict future cardiovascular events better than each test alone.
  
  
  RESULTS
  From November 2000 to March 2008, 274 consecutive elderly subjects (men/women; 114/160, mean age; 71 ± 12 years) were enrolled in this study. We measured IMT, FMD, and PWV in all of these subjects and followed them for a mean of 41 ± 28 months. During the follow-up period, vascular events occurred in 42 patients (15.3%). IMT (hazard ratio = 1.28 [95%CI, 1.09-1.50], p = 0.002 per 0.1 mm increase in mean IMT) and brachial-ankle (ba) PWV (hazard ratio = 1.06 [95%CI, 1.01-1.10], p = 0.015 per 1 m/s increase in baPWV) were independent predictors of future vascular events by Cox proportional hazard analysis, although FMD did not reach statistical significance (hazard ratio = 0.85 [95%CI, 0.72-1.01], p = 0.062 per 1% increase in %FMD). Importantly, the number of tests showing results in the worst tertile was a more powerful predictor (hazard ratio = 2.21 [95%CI, 1.42-3.43], p = 0.0004 for number of tests showing worst tertile) of future vascular events than either IMT, baPWV, or FMD alone. When both IMT and baPWV (with respective cut-off values of 0.98 mm and 19.1 m/s) were taken into consideration, the efficacy increased as compared with each test alone (odds ratio 4.9).
  
  
  CONCLUSIONS
  These results indicate that IMT and baPWV, especially when combined, are useful in predicting future vascular events in elderly subjects.
authors.affiliation: Department of Geriatric Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan.
authors.forename: Kumiko
authors.initials: K
authors.lastname: Nagai
authors.forename: Shigeki
authors.initials: S
authors.lastname: Shibata
authors.forename: Masahiro
authors.initials: M
authors.lastname: Akishita
authors.forename: Noriko
authors.initials: N
authors.lastname: Sudoh
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Obara
authors.forename: Kenji
authors.initials: K
authors.lastname: Toba
authors.forename: Koichi
authors.initials: K
authors.lastname: Kozaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis* / Q000473:pathology; D001916:Brachial Artery / Q000473:pathology*; D002339:Carotid Arteries / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D004730:Endothelium, Vascular / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D063177:Pulse Wave Analysis; D014664:Vasodilation
keywords: Flow-mediated dilation; Intima-media thickness; Pulse wave velocity; Vascular event