September 3, 2005Open Access
View Full PaperA Comparison of Three Different Methods to Evaluate Endothelium-Dependent Vasodilation in the Elderly
Structured PICO
Are three different methods to evaluate endothelium-dependent vasodilation feasible and associated with coronary risk in an elderly population?
P
Population
1016 subjects aged 70 years from the population-based Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study
I
Intervention
Evaluation of endothelium-dependent vasodilation using three techniques: invasive forearm technique with acetylcholine (EDV), brachial artery ultrasound (FMD), and pulse wave analysis with terbutaline provocation
O
Outcome
Feasibility (success rate) and usefulness (correlation with Framingham risk score)surrogate
Invasive forearm technique and FMD are feasible and independently associated with increased coronary risk in the elderly, providing complementary information on endothelial function.
Abstract
BACKGROUND: Three different techniques to evaluate endothelium-dependent vasodilation in the peripheral circulation have been described but not simultaneously tested in a large-scale population-based setting. This study aimed to evaluate the feasibility and usefulness of these techniques in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. METHODS AND RESULTS: In the population-based PIVUS study (1016 subjects aged 70 years), the invasive forearm technique with acetylcholine given in the brachial artery (EDV), the brachial artery ultrasound technique with measurement of flow-mediated dilatation (FMD), and the pulse wave analysis method with beta-2-agonist (terbutaline) provocation were successfully used in 87%, 97%, and 86% of the sample, respectively. The results of EDV and pulse wave analysis were interrelated (r=0.12, P=0.0013), but no relationships were found with FMD measurements. All 3 techniques were correlated to the Framingham risk score (r=0.10 to 0.12, P=0.0007 to 0.001). In multiple regression analysis, however, only EDV and FMD were independently associated with the Framingham score. CONCLUSIONS: All 3 evaluated techniques were feasible to perform in a general elderly population. Both the invasive forearm technique and FMD were independently associated with increased coronary risk, suggesting that information on conduit artery and resistance artery endothelial function carry different, but important, information in the elderly. If the invasive technique cannot be used, the pulse wave based technique is an alternative.