title: Cross-Sectional Associations of Flow Reversal, Vascular Function, and Arterial Stiffness in the Framingham Heart Study.
abstract: Experimental studies link oscillatory flow accompanied by flow reversal to impaired endothelial cell function. The relation of flow reversal with vascular function and arterial stiffness remains incompletely defined.
  
  
  
  We measured brachial diastolic flow patterns along with vasodilator function in addition to tonometry-based central and peripheral arterial stiffness in 5708 participants (age 47±13 years, 53% women) in the Framingham Heart Study Offspring and Third Generation cohorts. Brachial artery diastolic flow reversal was present in 35% of the participants. In multivariable regression models, the presence of flow reversal was associated with lower flow-mediated dilation (3.9±0.2 versus 5.0±0.2%; P<0.0001) and reactive hyperemic flow velocity (50±0.99 versus 57±0.93 cm/s; P<0.0001). The presence of flow reversal (compared with absence) was associated with higher central aortic stiffness (carotid-femoral pulse wave velocity 9.3±0.1 versus 8.9±0.1 m/s), lower muscular artery stiffness (carotid-radial pulse wave velocity 9.6±0.1 versus 9.8±0.1 m/s), and higher forearm vascular resistance (5.32±0.03 versus 4.66±0.02 log dyne/s/cm5; P<0.0001). The relations of diastolic flow velocity with flow-mediated dilation, aortic stiffness, and forearm vascular resistance were nonlinear, with a steeper decline in vascular function associated with increasing magnitude of flow reversal.
  
  
  
  In our large, community-based sample, brachial artery flow reversal was common and associated with impaired vasodilator function and higher aortic stiffness. Our findings are consistent with the concept that flow reversal may contribute to vascular dysfunction.
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors: Rosa
authors: R
authors: Bretón-Romero
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors: Na
authors: N
authors: Wang
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors: Joseph
authors: J
authors: Palmisano
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors: Martin G
authors: MG
authors: Larson
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors: Ramachandran S
authors: RS
authors: Vasan
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors: Gary F
authors: GF
authors: Mitchell
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors: Emelia J
authors: EJ
authors: Benjamin
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.).
authors: Joseph A
authors: JA
authors: Vita
authors: From the Boston University's and the National Heart, Lung, and Blood Institute's Framingham Heart Study (M.G.L., R.S.V., E.J.B.), MA; Cardiology (R.S.V., E.J.B., J.A.V., N.M.H.) and Preventive Medicine Sections (R.S.V., E.J.B.), and Whitaker Cardiovascular Institute, School of Medicine (R.B.-R., R.S.V., E.J.B., J.A.V., N.M.H.), School of Public Health (N.W., J.P., M.G.L., R.S.V., E.J.B.), and Departments of Mathematics and Statistics (M.G.L.), Boston University, MA; and Cardiovascular Engineering Inc, Norwood, MA (G.F.M.). nhamburg@bu.edu.
authors: Naomi M
authors: NM
authors: Hamburg
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000503:physiopathology; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D016014:Linear Models; D008297:Male; D008365:Manometry; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D017711:Nonlinear Dynamics; D016017:Odds Ratio; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D012307:Risk Factors; D018617:Ultrasonography, Doppler, Pulsed; D014655:Vascular Resistance; D059289:Vascular Stiffness; D014664:Vasodilation
keywords: arterial stiffness; endothelium; epidemiology; hyperemia; vascular function