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Long-term association of brachial artery flow-mediated vasodilation and cardiovascular events in middle-aged subjects with no apparent heart disease.
Int J Cardiol 2009; 134(1):52-8IJ

Abstract

BACKGROUND

Endothelial dysfunction is considered an important prognostic factor in atherosclerosis. The aim of this study was to detect the long-term association of peripheral vascular endothelial function and clinical outcome in healthy subjects without apparent coronary artery disease (CAD).

METHODS

We prospectively assessed brachial flow-mediated dilation (FMD) in 435 consecutive healthy subjects: 281 (65%) men, mean age 54+/-12 years and body mass index 28+/-4 kg/m(2). After overnight fasting and discontinuation of all medications for > or =12 h, FMD and endothelium-independent nitroglycerin-mediated vasodilation were assessed using high resolution linear array ultrasound.

RESULTS

Subjects were divided into 2 groups: below (n=221) and above (n=214) the median FMD of 10.7%, and were comparable regarding CAD risk factors, lipoproteins, fasting glucose, C-reactive protein, and concomitant medications, with a mean clinical follow-up of 32+/-2 months. Composite cardiovascular endpoints (all-cause mortality, non-fatal myocardial infarction, heart failure or angina pectoris hospitalization, stroke, coronary artery bypass grafting and percutaneous coronary interventions) were significantly more common in subjects with below median FMD of 10.7%, than above (11.8% vs 4.7%, p=0.007, respectively). Univariate analysis demonstrated that median FMD significantly predicted cardiovascular events [odds ratio (OR) of 2.78 and 95% CI 1.35 to 5.71 (p=0.003)]. After multivariate analysis including conventional CAD risk factors, median FMD was the best independent predictor of long-term cardiovascular adverse events [OR of 2.70 and 95% CI 1.16 to 6.32 (p=0.011)].

CONCLUSIONS

Brachial artery median FMD independently predicts long-term adverse cardiovascular events in healthy subjects in addition to traditional risk factor assessment.

Authors+Show Affiliations

Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel. shechtes@netvision.net.ilNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

18479768

Citation

Shechter, Michael, et al. "Long-term Association of Brachial Artery Flow-mediated Vasodilation and Cardiovascular Events in Middle-aged Subjects With No Apparent Heart Disease." International Journal of Cardiology, vol. 134, no. 1, 2009, pp. 52-8.
Shechter M, Issachar A, Marai I, et al. Long-term association of brachial artery flow-mediated vasodilation and cardiovascular events in middle-aged subjects with no apparent heart disease. Int J Cardiol. 2009;134(1):52-8.
Shechter, M., Issachar, A., Marai, I., Koren-Morag, N., Freinark, D., Shahar, Y., ... Feinberg, M. S. (2009). Long-term association of brachial artery flow-mediated vasodilation and cardiovascular events in middle-aged subjects with no apparent heart disease. International Journal of Cardiology, 134(1), pp. 52-8. doi:10.1016/j.ijcard.2008.01.021.
Shechter M, et al. Long-term Association of Brachial Artery Flow-mediated Vasodilation and Cardiovascular Events in Middle-aged Subjects With No Apparent Heart Disease. Int J Cardiol. 2009 May 1;134(1):52-8. PubMed PMID: 18479768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term association of brachial artery flow-mediated vasodilation and cardiovascular events in middle-aged subjects with no apparent heart disease. AU - Shechter,Michael, AU - Issachar,Assaf, AU - Marai,Ibrahim, AU - Koren-Morag,Nira, AU - Freinark,Dov, AU - Shahar,Yael, AU - Shechter,Alon, AU - Feinberg,Micha S, Y1 - 2008/05/13/ PY - 2007/07/31/received PY - 2007/12/20/revised PY - 2008/01/11/accepted PY - 2008/5/16/pubmed PY - 2009/7/17/medline PY - 2008/5/16/entrez SP - 52 EP - 8 JF - International journal of cardiology JO - Int. J. Cardiol. VL - 134 IS - 1 N2 - BACKGROUND: Endothelial dysfunction is considered an important prognostic factor in atherosclerosis. The aim of this study was to detect the long-term association of peripheral vascular endothelial function and clinical outcome in healthy subjects without apparent coronary artery disease (CAD). METHODS: We prospectively assessed brachial flow-mediated dilation (FMD) in 435 consecutive healthy subjects: 281 (65%) men, mean age 54+/-12 years and body mass index 28+/-4 kg/m(2). After overnight fasting and discontinuation of all medications for > or =12 h, FMD and endothelium-independent nitroglycerin-mediated vasodilation were assessed using high resolution linear array ultrasound. RESULTS: Subjects were divided into 2 groups: below (n=221) and above (n=214) the median FMD of 10.7%, and were comparable regarding CAD risk factors, lipoproteins, fasting glucose, C-reactive protein, and concomitant medications, with a mean clinical follow-up of 32+/-2 months. Composite cardiovascular endpoints (all-cause mortality, non-fatal myocardial infarction, heart failure or angina pectoris hospitalization, stroke, coronary artery bypass grafting and percutaneous coronary interventions) were significantly more common in subjects with below median FMD of 10.7%, than above (11.8% vs 4.7%, p=0.007, respectively). Univariate analysis demonstrated that median FMD significantly predicted cardiovascular events [odds ratio (OR) of 2.78 and 95% CI 1.35 to 5.71 (p=0.003)]. After multivariate analysis including conventional CAD risk factors, median FMD was the best independent predictor of long-term cardiovascular adverse events [OR of 2.70 and 95% CI 1.16 to 6.32 (p=0.011)]. CONCLUSIONS: Brachial artery median FMD independently predicts long-term adverse cardiovascular events in healthy subjects in addition to traditional risk factor assessment. SN - 1874-1754 UR - https://www.unboundmedicine.com/medline/citation/18479768/Long_term_association_of_brachial_artery_flow_mediated_vasodilation_and_cardiovascular_events_in_middle_aged_subjects_with_no_apparent_heart_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0167-5273(08)00311-2 DB - PRIME DP - Unbound Medicine ER -