Microvascular Function Predicts Cardiovascular Events in Primary Prevention: Long-Term Results From the Firefighters and Their Endothelium (FATE) Study

• Published in: Circulation (New York, N.Y.) N.Y.), 2011-01, Vol.123 (2), p.163-169
• Main Authors: ANDERSON, Todd J, CHARBONNEAU, Francois, TITLE, Lawrence M, BUITHIEU, Jean, ROSE, M. Sarah, CONRADSON, Heather, HILDEBRAND, Kathy, FUNG, Marinda, VERMA, Subodh, LONN, Eva M
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood and lymphatic vessels; Blood Flow Velocity - physiology; Brachial Artery - physiology; C-Reactive Protein - metabolism; Cardiology. Vascular system; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - physiopathology; Cardiovascular Diseases - prevention & control; Cohort Studies; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endothelium, Vascular - physiology; Follow-Up Studies; Humans; Longitudinal Studies; Male; Medical sciences; Microvessels - physiology; Middle Aged; Predictive Value of Tests; Proportional Hazards Models; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Tunica Intima - diagnostic imaging; Tunica Media - diagnostic imaging; Ultrasonography
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.110.953653

Biomarkers of atherosclerosis may refine clinical decision making in individuals at risk of cardiovascular disease. The purpose of the study was to determine the prognostic significance of endothelial function and other vascular markers in apparently healthy men. The cohort consisted of 1574 men (age, 49.4 years) free of vascular disease. Measurements included flow-mediated dilation and its microvascular stimulus, hyperemic velocity, carotid intima-media thickness, and C-reactive protein. Cox proportional hazard models evaluated the relationship between vascular markers, Framingham risk score, and time to a first composite cardiovascular end point of vascular death, revascularization, myocardial infarction, angina, and stroke. Subjects had low median Framingham risk score (7.9%). Cardiovascular events occurred in 71 subjects (111 events) over a mean follow-up of 7.2±1.7 years. Flow-mediated dilation was not associated with subsequent cardiovascular events (hazard ratio, 0.92; P=0.54). Both hyperemic velocity (hazard ratio, 0.70; 95% confidence interval, 0.54 to 0.90; P=0.006) and carotid intima-media thickness (hazard ratio, 1.45; confidence interval, 1.15 to 1.83; P=0.002) but not C-reactive protein (P=0.35) were related to events in a multivariable analysis that included Framingham risk score (per unit SD). Furthermore, the addition of hyperemic velocity to Framingham risk score resulted in a net clinical reclassification improvement of 28.7% (P