title: Combined assessment of flow-mediated dilation of the brachial artery and brachial-ankle pulse wave velocity improves the prediction of future coronary events in patients with chronic coronary artery disease.
abstract: OBJECTIVE
  Measurement of either flow-mediated endothelium-dependent dilatation (FMD) of the brachial artery, brachial-ankle pulse wave velocity (baPWV), or intima-media thickness (IMT) of the carotid artery is useful for risk assessment of future cardiovascular events. This study examined whether combination of these vascular parameters may have an additive effect on the ability of traditional risk factors to predict coronary events in patients with chronic coronary artery disease (CAD).
  
  
  METHODS
  Patients (n=923) with stable CAD had measurements of FMD, baPWV, and maximum IMT (maxIMT), and were prospectively followed up for <8.5 years or until a coronary event - cardiac death, non-fatal myocardial infarction (MI) or unstable angina pectoris (uAP) requiring unplanned coronary revascularization.
  
  
  RESULTS
  During the follow-up period, 116 events occurred (29 cardiac deaths, 46 non-fatal MIs and 41 cases of uAP). A multivariate Cox proportional hazards analysis showed that FMD (HR 0.50, 95% CI 0.38-0.66) and baPWV (HR 1.52, 95% CI 1.27-1.82) but not maxIMT were significant predictors of coronary events. Based on the concordance statistics, the predictive value of traditional risk factors [area under the receiver operating characteristic curve (AUC), 0.67] was increased more by the addition of FMD and baPWV combined (AUC, 0.75) compared with the addition of either maxIMT, FMD, or baPWV alone, or the combination of maxIMT and FMD or maxIMT and baPWV (AUC, 0.67, 0.71, 0.71, 0.71 and 0.71, respectively).
  
  
  CONCLUSIONS
  The combined addition of FMD and baPWV to the risk assessment algorithms may be useful for risk stratification of chronic CAD patients.
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Sugamata
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan. Electronic address: takanaka@yamanashi.ac.jp.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Uematsu
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kitta
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fujioka
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Saito
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Kawabata
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Jun-ei
authors.initials: JE
authors.lastname: Obata
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Kugiyama
mesh_terms: D000368:Aged; D000789:Angina, Unstable; D055109:Ankle Brachial Index; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000473:pathology* / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology*; D003643:Death; D004108:Dilatation, Pathologic; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction; D063177:Pulse Wave Analysis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
keywords: Endothelial function; Follow-up study; Intima-media thickness; Pulse wave velocity