Brachial artery flow-mediated dilatation was significantly associated with the progression of carotid intima-media thickness over 6.2 years, independent of conventional risk factors.
Cohort (n=213)
Does brachial artery flow-mediated dilatation predict the progression of carotid intima-media thickness better than conventional risk factors in late-middle-aged individuals at low to intermediate cardiovascular risk?
Systemic endothelial function, measured by flow-mediated dilatation, is a stronger predictor of preclinical carotid atherosclerosis progression over 6 years than conventional risk factors.
BACKGROUND: Endothelial dysfunction develops early and has been shown to predict the development of clinical complications of atherosclerosis. However, the relationship between early endothelial dysfunction and the progression of arterial disease in the general population is unknown. We investigated endothelial dysfunction, risk factors, and progression of carotid intima-media thickness (cIMT) in late-middle-aged individuals at low to intermediate cardiovascular risk in a prospective study between 1997 and 2005. METHODS AND RESULTS: Brachial artery flow-mediated dilatation and cIMT were measured in 213 nonsmoking British civil servants recruited from a prospective cohort (Whitehall II study). Participants (age, 45 to 66 years) were free of clinical cardiovascular disease and diabetes mellitus. Risk factors and Framingham Risk Score were determined at baseline. cIMT was repeated 6.2+/-0.4 years later. At baseline, age, blood pressure, low-density lipoprotein cholesterol, and Framingham Risk Score correlated with cIMT. However, only flow-mediated dilatation, not risk factors or Framingham Risk Score, was associated with average annual progression of cIMT. This relationship remained significant after adjustment for risk factors whether entered as separate variables or as Framingham Risk Score. Further adjustment for waist circumference, triglycerides, and employment grade had no significant effect. CONCLUSIONS: Systemic endothelial function was associated with progression of preclinical carotid arterial disease over a 6-year period and was more closely related to cIMT changes than conventional risk factors. Thus, the relationship between endothelial dysfunction and adverse outcome is likely to be due not only to destabilization of established disease in high-risk populations but also to its impact on the evolution of the atherosclerotic substrate. Flow-mediated dilatation testing provides an integrated vascular measure that may aid the prediction of structural disease evolution and represents a potential short- to intermediate-term outcome measure for evaluation of preventive treatment strategies.
Halcox et al. (2009) conducted a cohort in Low to intermediate cardiovascular risk (n=213). Brachial artery flow-mediated dilatation was evaluated on Average annual progression of carotid intima-media thickness (cIMT). Brachial artery flow-mediated dilatation was significantly associated with the progression of carotid intima-media thickness over 6.2 years, independent of conventional risk factors.