Introduction:
The integrated flow-mediated vasodilation (FMD) response was shown to be associated with cardiovascular risk factors, but the association between the integrated FMD response and consequent cardiovascular events has been unclear.
Hypothesis:
We assessed the hypothesis that the integrated FMD response predicts consequent cardiovascular events.
Methods:
We enrolled 575 patients who had at least one cardiovascular risk factor (hypertension, dyslipidemia, diabetes, or smoking). We measured the FMD magnitude of the percentage change in peak diameter (ΔFMD), and we measured the integrated FMD response calculated as the area under the dilation curve during a 120-sec dilation period (FMD-AUC
120
) using a semiautomatic edge-detection algorithm. The primary outcome was defined as any cardiovascular event (a composite of cardiovascular death, and hospitalization for myocardial infarction, stroke, or heart failure).
Results:
The mean duration of follow-up was 35±22 months (range: 1-74 months). During the follow-up period, 34 cardiovascular events were recorded. Among the elderly patients (age[[Unable to Display Character:  ]]≥[[Unable to Display Character:  ]]65 yrs, n[[Unable to Display Character:  ]]=[[Unable to Display Character:  ]]281), the patients with the lowest tertile of FMD-AUC
120
(FMD-AUC
120
<[[Unable to Display Character:  ]]5.6) suffered a higher incidence of cardiovascular events compared with the patients with the higher two tertiles (FMD-AUC
120
≥[[Unable to Display Character:  ]]5.6) (log rank 4.16, p=0.041). The association remained significant after adjusting for age, gender and office systolic blood pressure (hazard ratio 1.25, p=0.039). In the younger patients (age[[Unable to Display Character:  ]]<[[Unable to Display Character:  ]]65 yrs, n[[Unable to Display Character:  ]]=[[Unable to Display Character:  ]]294), cardiovascular events were similar among the patients with the lowest tertile and those with the higher two tertiles of FMD-AUC
120
. Cardiovascular events were also similar in the patients with the lowest tertile and the higher two tertiles of ΔFMD in both the elderly and younger patients.
Conclusions:
The integrated FMD response, but not ΔFMD, predicted cardiovascular events in elderly patients with a cardiovascular risk factor.
Prospective Relationship of Low Cardiovascular Risk Factor Profile at Younger Ages to Ankle‐Brachial Index: 39‐Year Follow‐Up—The Chicago Healthy Aging Study
