The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort

Shimbo, Daichi; Grahame-Clarke, Cairistine; Miyake, Yumiko; Rodríguez, Carlos J.; Sciacca, Robert R.; Tullio, Marco Di; Boden‐Albala, Bernadette; Sacco, Ralph L.; Homma, Shunichi

doi:10.1016/j.atherosclerosis.2006.05.005

Cited by 192 publications

(144 citation statements)

References 36 publications

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“…In a prospective 3-year study in low cardiovascular risk patients, Shimbo et al 10 find that lower FMD values are connected with an increased risk of major adverse cardiovascular events. However, this correlation loses statistical significance after controlling for the presence of risk factors in multivariate regression analysis.…”

Section: Discussionmentioning

confidence: 99%

Endothelial function in patients with and without diabetes mellitus with different degrees of coronary artery stenosis

Симова

Денчев

Dimitrov

et al. 2008

J of Clinical Ultrasound

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Purpose. To evaluate endothelial function using flow-mediated dilatation (FMD) of the brachial artery in patients with and without diabetes mellitus (DM) with different degrees of coronary artery stenosis.Method. We investigated 293 patients, 69 (23.6%) of whom had DM. FMD and coronary arteriography were performed.Results. Patients with DM had a significantly lower FMD (mean 6 SD, 3.7 6 3.8%) compared with patients without DM (mean 6 SD, 5.2 6 5.3%) (p < 0.05). When the results were broken down by the severity of coronary artery disease (CAD) (no significant coronary artery stenosis, 1-vessel disease, 2-vessel disease, and 3-vessel disease) the only statistically significant difference between diabetics and nondiabetics was found in patients without significant coronary stenosis (mean FMD 6 SD: 5.2 6 4.4% in diabetics, 7.6 6 5.4% in nondiabetics [p < 0.05]).Conclusion. In CAD patients, the presence of DM was associated with endothelial dysfunction. The difference in the FMD was clearly expressed between patients with and without DM in the subgroup without significant coronary stenosis, and was no longer present with advanced coronary atherosclerosis. The increased cardiovascular risk in patients with DM is caused by multiple and not entirely understood factors. Hyperglycemic status itself plays a role, but other cardiovascular risk factors including obesity, dyslipidemia, and arterial hypertension contribute to the progression of the atherosclerotic process. Endothelial dysfunction appears early in the chain of pathophysiologic changes.Endothelium-dependent flow-mediated dilatation (FMD) of the brachial artery is a method capable of detecting endothelial dysfunction. It was first introduced into clinical practice by Celermajer et al. 2 The method evaluates the capacity of endothelial cells to respond to pathologic vasoconstrictive stimuli with an enhanced production and bioavailability of nitric oxide and a consequent vasodilatation. The response of a peripheral artery to an increase in the shear stress reflects the endothelial function and correlates with the degree of coronary artery atherosclerotic involvement. 3 The purpose of this study was to evaluate the endothelial function in patients with and without various degrees of coronary artery stenosis.

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Section: Discussionmentioning

confidence: 99%

Endothelial function in patients with and without diabetes mellitus with different degrees of coronary artery stenosis

Симова

Денчев

Dimitrov

et al. 2008

J of Clinical Ultrasound

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“…Indeed, recent studies have failed to demonstrate any significant correlation between FMD and IMT in healthy subjects. 2 Prior studies have demonstrated that impaired FMD 3 and increased IMT 4 are independently associated with an increased risk of cardiovascular events. Nevertheless, recent studies have yielded inconsistent findings on the relative predictive values of FMD and IMT for cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

Gender Differences on Brachial Flow‐mediated Dilation and Carotid Intima‐media Thickness for Prediction of Spontaneous Cardiovascular Events

Wang

Lau

et al. 2008

Clinical Cardiology

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Background: Impaired brachial flow-mediated dilation (FMD) and increased carotid intima-media thickness (IMT) are associated with increased risk of cardiovascular events. Methods: We measured brachial FMD and a mean of 12 sites maximum carotid IMT (mmIMT) in 279 patients (mean age 62±12 y; 163 men) admitted for coronary angiography due to chest pain. Hypothesis: There are gender differences in the predictive values of FMD and IMT for cardiovascular events. Results: Univariable analysis showed that impaired FMD (p<0.001), but not increased mmIMT (p = 0.056), significantly predicted spontaneous cardiovascular events. After adjusting for the extent of coronary artery disease (CAD) and other clinical variables, age (heart rate [HR] 1.05, 95% confidence interval [CI]: 1.01-1.09, p = 0.017) and FMD (HR 0.85, 95% CI: 0.75-0.97, p = 0.012) were independent predictors for cardiovascular events. A total of 148 (53%) patients had CAD (≥50% diameter stenosis). Over a median follow-up of 16 mo, 36 (12.9%) patients experienced spontaneous cardiovascular events (cardiovascular death, stroke, acute myocardial infarction [MI], unstable angina pectoris, and congestive heart failure [HF]). Women were more likely than men to develop cardiovascular events in patients without significant CAD (11.9% versus 1.6%, odds ratio [OR] = 8.54, p = 0.033), but not in those patients with CAD (20.4 % versus 17.2%, OR = 1.24, p = 0.66). Moreover, women accounted for 8 (88.9%) events in non-CAD patients. Furthermore, impaired FMD predicted the occurrence of cardiovascular events in both men and women (p<0.05). Conclusion: Brachial FMD, rather than carotid IMT, was an independent predictor for cardiovascular events after adjusting for the extent of CAD. Moreover, impaired brachial endothelial function in women without significant CAD was associated with an increased risk of spontaneous cardiovascular events.Key words: flow-mediated dilation, intima-media thickness, coronary artery disease, cardiovascular events Introduction Noninvasive assessments of brachial artery flow-mediated dilation (FMD) and carotid artery intima-media thickness (IMT) have been widely used as surrogate markers for subclinical atherosclerosis. 1 However, these 2 parameters measure different aspects and stages of early atherosclerosis: IMT detects early morphological changes, but FMD provides functional alteration of the arterial wall. Indeed, recent studies have failed to demonstrate any significant correlation between FMD and IMT in healthy subjects. 2 Prior studies have demonstrated that impaired FMD 3 and increased IMT 4 are independently associated with an increased risk of cardiovascular events. Nevertheless, recent studies have yielded inconsistent findings on the relative predictive values of FMD and IMT for cardiovascular events. 5 In the majority of studies, 3 -7 only male subjects were included. The gender difference on the predictive values of IMT and FMD may account for this conflicting result. Currently, there is very limited gender-specific data on the predictiv...

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“…There is, however, a paucity of data on the predictive value of brachial FMD for incident cardiovascular events in low-risk populations or subjects free of CVD at baseline. The study by Shimbo et al [15,39] attempted to address this question, but their findings were inconclusive due to small sample size and less ethnically diverse cohort compared with the USA population. In contrast, in the current study an inverse association between FMD and clinical CVD events remained significant after adjustment for multiple cardiovascular disease risk factors or for the FRS (Framingham risk score).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of endothelial dysfunction in patients with type 2 diabetes mellitus – Analysis of 100 cases

Venkateshwarlu¹,

Gandiah²,

J³

et al. 2016

Int J of Biomed & Adv Res

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Background: Atherosclerosis which is a precursor for macro-vascular disease involves both functional as well as structural changes in the vasculature. Functional changes involve abnormalities in endothelium, vascular smooth muscle cells and platelet functions. Endothelial dysfunction was reported in type 2 DM cases. Ultrasound assessment of brachial artery FMD (Flow Mediated Dilatation) provides important information about vascular function in health and disease. Low FMD values predict independently an established atherosclerosis. Materials and methods: A total of 150 individuals included in this study; 100 were diabetes mellitus patients and 50 were age matched persons without diabetes, hypertension or vascular disease. Of 100 diabetes patients 50 each were grouped in two groups with good (HbA1c <7.5%) and poor (HbA1C >7.5%) control of hyperglycemia. Brachial artery flow mediated vasodilatation (FMD) was studied in all patient after overnight fasting (8 hours) using 7.5 MHz phased array transducer. The medial epicondyle was used as anatomical landmark for brachial artery. Observations: In this study it is observed that, the mean age for FMD <4.5% is 59.70±11.08 and FMD >4.5% is 56.53±8.37. Age is higher in diabetics with FMD % <4.5. Females who FMD <4.5% were 50.0% and 42.5% with FMD >4.5%. Smoking in diabetics with FMD <4.5% was 10.0% and FMD >4.5 % was 15%. Hypertension was equally found 40%. Family history of diabetes with FMD % <4.5 was 30% and FMD >4.5% were none. Summary and conclusions: The data suggest that endothelial function is a useful prognostic marker in coronary artery disease patients. In these patients, it has been reported that endothelial dysfunction is an independent prognostic factor and may predict future events, irrespective of the angiographic severity of the disease. Moreover, blunted endothelial function may reflect early atherosclerosis, and should lead to a detailed evaluation.

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The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort

Cited by 192 publications

References 36 publications

Endothelial function in patients with and without diabetes mellitus with different degrees of coronary artery stenosis

Endothelial function in patients with and without diabetes mellitus with different degrees of coronary artery stenosis

Gender Differences on Brachial Flow‐mediated Dilation and Carotid Intima‐media Thickness for Prediction of Spontaneous Cardiovascular Events

Evaluation of endothelial dysfunction in patients with type 2 diabetes mellitus – Analysis of 100 cases

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