The relative importance of vascular structure and function in predicting cardiovascular events

• Published in: Journal of the American College of Cardiology 2004-02, Vol.43 (4), p.616-623
• Main Authors: Fathi, Robert, Haluska, Brian, Isbel, Nicole, Short, Leanne, Marwick, Thomas H
• Format: Article
• Language: English
• Subjects: Arteriosclerosis - diagnosis; Arteriosclerosis - epidemiology; Arteriosclerosis - physiopathology; Brachial Artery - physiology; Cardiology; Cardiovascular disease; Carotid Artery, Common - diagnostic imaging; Cholesterol; Cohort Studies; Coronary Disease - mortality; Coronary Disease - pathology; Coronary Disease - physiopathology; Coronary vessels; Disease-Free Survival; Echocardiography; Echocardiography, Stress; Endothelium, Vascular - physiology; Female; Heart attacks; Humans; Low density lipoprotein; Male; Middle Aged; Prognosis; Proportional Hazards Models; Prospective Studies; Renal Dialysis; Risk Factors; Tunica Intima - diagnostic imaging; Tunica Media - diagnostic imaging; Vasodilation - physiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2003.09.042

We sought to assess the prognostic utility of brachial artery reactivity (BAR) in patients at risk of cardiovascular events. Impaired flow-mediated vasodilation measured by BAR is a marker of endothelial dysfunction. Brachial artery reactivity is influenced by risk factors and is responsive to various pharmacological and other treatments. However, its prognostic importance is uncertain, especially relative to other predictors of outcome. A total of 444 patients were prospectively enrolled to undergo BAR and follow-up. These patients were at risk of cardiovascular events, based on the presence of risk factors or known or suspected cardiovascular disease. We took a full clinical history, performed BAR, and obtained carotid intima-media thickness (IMT) and left ventricular mass and ejection fraction. Patients were followed up for cardiovascular events and all-cause mortality. Multivariate Cox regression analysis was performed to assess the independent association of investigation variables on outcomes. The patients exhibited abnormal BAR (5.2 ± 6.1% [mean ± SD]) but showed normal nitrate-mediated dilation (9.9 ± 7.2%) and normal mean IMT (0.67 ± 0.12 mm [average]). Forty-nine deaths occurred over the median follow-up period of 24 months (interquartile range 10 to 34). Patients in the lowest tertile group of BAR (