Brachial Flow-Mediated Dilation Predicts Incident Cardiovascular Events in Older Adults The Epidemiology

Background —The relationship between impaired brachial flow-mediated dilation (FMD) and subsequent clinical cardiovascular events is not well established, especially in older adults whose FMD is often diminished. We assessed the hypothesis that FMD predicts incident cardiovascular events in a population-based cohort of older adults. Methods and Results —FMD was measured at the 1997 to 1998 Cardiovascular Health Study clinic visit in 2792 adults aged 72 to 98 years (82.7% white, 58.6% women) recruited at 4 clinic sites in the United States. Log-rank test and Cox proportional hazard models were used to examine the association between FMD and adjudicated cardiovascular events. A total of 674 subjects (24.1%) had an adjudicated event over the 5-year follow-up period. Event-free survival rates for cardiovascular events were significantly higher in subjects with FMD greater than the sex-specific medians than in subjects with FMD less than or equal to the sex-specific medians (78.3% versus 73.6%, log-rank P (cid:1) 0.006). FMD remained a significant predictor of cardiovascular events after adjustment for age, gender, diabetes mellitus, cigarette smoking, systolic and diastolic blood pressure, baseline cardiovascular disease status, and total cholesterol (hazard ratio, 0.91 [95% CI, 0.83 to 0.99], P (cid:1) 0.02 per unit SD of FMD) but added only (cid:2) 1% to the prognostic accuracy of the best Cox model. Brachial artery diameter was also predictive of CV events in the adjusted Cox proportional hazard model (hazard ratio, 1.12 [95% CI, 1.02 to 1.28], P (cid:1) 0.025) and also added (cid:2) 1% to the accuracy of our best Cox model. Conclusions —FMD is a predictor of future cardiovascular events but adds very little to the prognostic accuracy of traditional cardiovascular risk scores/factors in older adults. FMD and brachial artery diameter may have similar predictive values for cardiovascular events in older adults. ( Circulation . 2007;115:2390-2397.) measure used as a research tool to quantify function.

[1]  R. Sacco,et al.  The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort. , 2007, Atherosclerosis.

[2]  B. Parker,et al.  Age and flow-mediated dilation: a comparison of dilatory responsiveness in the brachial and popliteal arteries. , 2006, American journal of physiology. Heart and circulatory physiology.

[3]  Rudolf Berger,et al.  Flow-mediated vasodilation predicts outcome in patients with chronic heart failure: comparison with B-type natriuretic peptide. , 2005, Journal of the American College of Cardiology.

[4]  H. Ulmer,et al.  Prognostic value of brachial artery endothelial function and wall thickness. , 2005, Journal of the American College of Cardiology.

[5]  François Mach,et al.  Inflammation and Atherosclerosis , 2004, Herz.

[6]  T. Marwick,et al.  The relative importance of vascular structure and function in predicting cardiovascular events. , 2004, Journal of the American College of Cardiology.

[7]  Massimo Chiariello,et al.  Endothelial Dysfunction and Cardiovascular Risk Prediction in Peripheral Arterial Disease: Additive Value of Flow-Mediated Dilation to Ankle-Brachial Pressure Index , 2003, Circulation.

[8]  J. Keaney,et al.  The clinical implications of endothelial dysfunction. , 2003, Journal of the American College of Cardiology.

[9]  A. Ignaszewski,et al.  The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease. , 2003, Journal of the American College of Cardiology.

[10]  M. Watkins,et al.  Predictive value of noninvasively determined endothelial dysfunction for long-term cardiovascular events in patients with peripheral vascular disease. , 2003, Journal of the American College of Cardiology.

[11]  J. Keaney,et al.  Endothelial function: a barometer for cardiovascular risk? , 2002, Circulation.

[12]  M. Watkins,et al.  Risk Stratification for Postoperative Cardiovascular Events via Noninvasive Assessment of Endothelial Function: A Prospective Study , 2002, Circulation.

[13]  E. Benjamin,et al.  Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. , 2002, Journal of the American College of Cardiology.

[14]  W. Riley,et al.  Estrogen Replacement and Brachial Artery Flow-Mediated Vasodilation in Older Women , 2001, Arteriosclerosis, thrombosis, and vascular biology.

[15]  W. Riley,et al.  Brachial Flow-Mediated Vasodilator Responses in Population-Based Research: Methods, Reproducibility and Effects of Age, Gender and Baseline Diameter , 2001, Journal of cardiovascular risk.

[16]  M. Hijmering,et al.  Variability of flow mediated dilation: consequences for clinical application. , 2001, Atherosclerosis.

[17]  F. Perticone,et al.  Prognostic Significance of Endothelial Dysfunction in Hypertensive Patients , 2001, Circulation.

[18]  K. Kostner,et al.  Late prognostic value of flow-mediated dilation in the brachial artery of patients with chest pain. , 2000, The American journal of cardiology.

[19]  K. Williams,et al.  Atherosclerosis--an inflammatory disease. , 1999, The New England journal of medicine.

[20]  L. Kuller,et al.  Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study. , 1995, Annals of epidemiology.

[21]  L H Kuller,et al.  Surveillance and ascertainment of cardiovascular events. The Cardiovascular Health Study. , 1995, Annals of epidemiology.

[22]  M. Cushman,et al.  Laboratory methods and quality assurance in the Cardiovascular Health Study. , 1995, Clinical chemistry.

[23]  J. Gardin,et al.  Assessment of cerebrovascular disease in the Cardiovascular Health Study. , 1993, Annals of epidemiology.

[24]  J. K. Lloyd,et al.  Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis , 1992, The Lancet.

[25]  R. Kronmal,et al.  The Cardiovascular Health Study: design and rationale. , 1991, Annals of epidemiology.

[26]  E. DeLong,et al.  Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. , 1988, Biometrics.