Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
Circulation. 2007;115:2390-2397
Published online before print April 23, 2007, doi: 10.1161/CIRCULATIONAHA.106.678276
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
115/18/2390    most recent
CIRCULATIONAHA.106.678276v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yeboah, J.
Right arrow Articles by Herrington, D. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Yeboah, J.
Right arrow Articles by Herrington, D. M.
Related Collections
Right arrow Cerebrovascular disease/stroke
Right arrow Risk Factors
Right arrow Chronic ischemic heart disease
Right arrow Epidemiology
Right arrow Endothelium/vascular type/nitric oxide

(Circulation. 2007;115:2390-2397.)
© 2007 American Heart Association, Inc.


Epidemiology

Brachial Flow-Mediated Dilation Predicts Incident Cardiovascular Events in Older Adults

The Cardiovascular Health Study

Joseph Yeboah, MD; John R. Crouse, MD; Fang-Chi Hsu, PhD; Gregory L. Burke, MD, MS; David M. Herrington, MD, MHS

From the Departments of Internal Medicine/Cardiology and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.

Reprint requests to Joseph Yeboah, MD, Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail jyeboah{at}wfubmc.edu

Received November 22, 2006; accepted February 14, 2007.

Background— The relationship between impaired brachial flow-mediated dilation (FMD) and subsequent clinical cardiovascular events is not well established, especially in older adults whose FMD is often diminished. We assessed the hypothesis that FMD predicts incident cardiovascular events in a population-based cohort of older adults.

Methods and Results— FMD was measured at the 1997 to 1998 Cardiovascular Health Study clinic visit in 2792 adults aged 72 to 98 years (82.7% white, 58.6% women) recruited at 4 clinic sites in the United States. Log-rank test and Cox proportional hazard models were used to examine the association between FMD and adjudicated cardiovascular events. A total of 674 subjects (24.1%) had an adjudicated event over the 5-year follow-up period. Event-free survival rates for cardiovascular events were significantly higher in subjects with FMD greater than the sex-specific medians than in subjects with FMD less than or equal to the sex-specific medians (78.3% versus 73.6%, log-rank P=0.006). FMD remained a significant predictor of cardiovascular events after adjustment for age, gender, diabetes mellitus, cigarette smoking, systolic and diastolic blood pressure, baseline cardiovascular disease status, and total cholesterol (hazard ratio, 0.91 [95% CI, 0.83 to 0.99], P=0.02 per unit SD of FMD) but added only {approx}1% to the prognostic accuracy of the best Cox model. Brachial artery diameter was also predictive of CV events in the adjusted Cox proportional hazard model (hazard ratio, 1.12 [95% CI, 1.02 to 1.28], P=0.025) and also added {approx}1% to the accuracy of our best Cox model.

Conclusions— FMD is a predictor of future cardiovascular events but adds very little to the prognostic accuracy of traditional cardiovascular risk scores/factors in older adults. FMD and brachial artery diameter may have similar predictive values for cardiovascular events in older adults.


 

CLINICAL PERSPECTIVE




This article has been cited by other articles:


Home page
Eur J Heart FailHome page
M. Klosinska, T. Rudzinski, P. Grzelak, L. Stefanczyk, J. Drozdz, and M. Krzeminska-Pakula
Endothelium-dependent and -independent vasodilation is more attenuated in ischaemic than in non-ischaemic heart failure
Eur J Heart Fail, July 3, 2009; (2009) hfp091v1.
[Abstract] [Full Text] [PDF]


Home page
Vasc MedHome page
S. Y. Yeh, J. Doupis, S. Rahangdale, S. Horr, A. Malhotra, and A. Veves
Total serum bilirubin does not affect vascular reactivity in patients with diabetes
Vascular Medicine, May 1, 2009; 14(2): 129 - 136.
[Abstract] [PDF]


Home page
J. Clin. Endocrinol. Metab.Home page
J. P. Crandall, H. Shamoon, H. W. Cohen, M. Reid, S. Gajavelli, G. Trandafirescu, V. Tabatabaie, and N. Barzilai
Post-Challenge Hyperglycemia in Older Adults Is Associated with Increased Cardiovascular Risk Profile
J. Clin. Endocrinol. Metab., May 1, 2009; 94(5): 1595 - 1601.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
W. B. Chung, N. M. Hamburg, M. Holbrook, S. M. Shenouda, M. M. Dohadwala, D. F. Terry, N. Gokce, and J. A. Vita
The Brachial Artery Remodels to Maintain Local Shear Stress Despite the Presence of Cardiovascular Risk Factors
Arterioscler. Thromb. Vasc. Biol., April 1, 2009; 29(4): 606 - 612.
[Abstract] [Full Text] [PDF]


Home page
Ann Rheum DisHome page
I C van Eijk, M J L Peters, E H Serne, I E van der Horst-Bruinsma, B A C Dijkmans, Y M Smulders, and M T Nurmohamed
Microvascular function is impaired in ankylosing spondylitis and improves after tumour necrosis factor {alpha} blockade
Ann Rheum Dis, March 1, 2009; 68(3): 362 - 366.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
J. Steffel and T. F. Luscher
Predicting the Development of Atherosclerosis
Circulation, February 24, 2009; 119(7): 919 - 921.
[Full Text] [PDF]


Home page
CirculationHome page
J. P.J. Halcox, A. E. Donald, E. Ellins, D. R. Witte, M. J. Shipley, E. J. Brunner, M. G. Marmot, and J. E. Deanfield
Endothelial Function Predicts Progression of Carotid Intima-Media Thickness
Circulation, February 24, 2009; 119(7): 1005 - 1012.
[Abstract] [Full Text] [PDF]


Home page
J Gerontol A Biol Sci Med SciHome page
L. A. Lesniewski, M. L. Connell, J. R. Durrant, B. J. Folian, M. C. Anderson, A. J. Donato, and D. R. Seals
B6D2F1 Mice Are a Suitable Model of Oxidative Stress-Mediated Impaired Endothelium-Dependent Dilation With Aging
J Gerontol A Biol Sci Med Sci, February 10, 2009; (2009) gln049v1.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Clin. Nutr.Home page
K. M Dickinson, J. B Keogh, and P. M Clifton
Effects of a low-salt diet on flow-mediated dilatation in humans
Am. J. Clinical Nutrition, February 1, 2009; 89(2): 485 - 490.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
Y. Kitta, J.-e. Obata, T. Nakamura, M. Hirano, Y. Kodama, D. Fujioka, Y. Saito, K.-i. Kawabata, K. Sano, T. Kobayashi, et al.
Persistent impairment of endothelial vasomotor function has a negative impact on outcome in patients with coronary artery disease.
J. Am. Coll. Cardiol., January 27, 2009; 53(4): 323 - 330.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
P. Ganz and P. Y. Hsue
Individualized approach to the management of coronary heart disease identifying the nonresponders before it is too late.
J. Am. Coll. Cardiol., January 27, 2009; 53(4): 331 - 333.
[Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
M. E. Widlansky
Shear stress and flow-mediated dilation: all shear responses are not created equally
Am J Physiol Heart Circ Physiol, January 1, 2009; 296(1): H31 - H32.
[Full Text] [PDF]


Home page
CirculationHome page
K. Pahkala, O. J. Heinonen, H. Lagstrom, P. Hakala, O. Simell, J. S.A. Viikari, T. Ronnemaa, M. Hernelahti, L. Sillanmaki, and O. T. Raitakari
Vascular Endothelial Function and Leisure-Time Physical Activity in Adolescents
Circulation, December 2, 2008; 118(23): 2353 - 2359.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
R. C. Thurston, K. Sutton-Tyrrell, S. A. Everson-Rose, R. Hess, and K. A. Matthews
Hot Flashes and Subclinical Cardiovascular Disease: Findings From the Study of Women's Health Across the Nation Heart Study
Circulation, September 16, 2008; 118(12): 1234 - 1240.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
M. Juonala, J. S.A. Viikari, M. Kahonen, T. Solakivi, H. Helenius, A. Jula, J. Marniemi, L. Taittonen, T. Laitinen, T. Nikkari, et al.
Childhood Levels of Serum Apolipoproteins B and A-I Predict Carotid Intima-Media Thickness and Brachial Endothelial Function in Adulthood: The Cardiovascular Risk in Young Finns Study
J. Am. Coll. Cardiol., July 22, 2008; 52(4): 293 - 299.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Clin. Nutr.Home page
L. Hooper, P. A Kroon, E. B Rimm, J. S Cohn, I. Harvey, K. A Le Cornu, J. J Ryder, W. L Hall, and A. Cassidy
Flavonoids, flavonoid-rich foods, and cardiovascular risk: a meta-analysis of randomized controlled trials
Am. J. Clinical Nutrition, July 1, 2008; 88(1): 38 - 50.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Clin. Nutr.Home page
E. P Weiss, H. Arif, D. T Villareal, E. Marzetti, and J. O Holloszy
Endothelial function after high-sugar-food ingestion improves with endurance exercise performed on the previous day
Am. J. Clinical Nutrition, July 1, 2008; 88(1): 51 - 57.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
G. L. Pierce, S. D. Beske, B. R. Lawson, K. L. Southall, F. J. Benay, A. J. Donato, and D. R. Seals
Weight Loss Alone Improves Conduit and Resistance Artery Endothelial Function in Young and Older Overweight/Obese Adults
Hypertension, July 1, 2008; 52(1): 72 - 79.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
U. Campia and J. A. Panza
Flavanol-rich cocoa a promising new dietary intervention to reduce cardiovascular risk in type 2 diabetes?
J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2150 - 2152.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
R. Vogel
Listening to the Endothelium: A Story of Signal and Noise
J. Am. Coll. Cardiol., May 20, 2008; 51(20): 1965 - 1966.
[Full Text] [PDF]


Home page
CirculationHome page
J. Simmonds, M. Fenton, C. Dewar, E. Ellins, C. Storry, D. Cubitt, J. Deanfield, N. Klein, J. Halcox, and M. Burch
Endothelial Dysfunction and Cytomegalovirus Replication in Pediatric Heart Transplantation
Circulation, May 20, 2008; 117(20): 2657 - 2661.
[Abstract] [Full Text] [PDF]


Home page
J Ultrasound MedHome page
W. P. Martins, C. O. Nastri, R. A. Ferriani, and F. M. Filho
Brachial Artery Pulsatility Index Change 1 Minute After 5-Minute Forearm Compression: Comparison With Flow-Mediated Dilatation
J. Ultrasound Med., May 1, 2008; 27(5): 693 - 699.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
V. Stangl, V. Witzel, G. Baumann, and K. Stangl
Current diagnostic concepts to detect coronary artery disease in women
Eur. Heart J., March 2, 2008; 29(6): 707 - 717.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Clin. Nutr.Home page
J. B Keogh, G. D Brinkworth, M. Noakes, D. P Belobrajdic, J. D Buckley, and P. M Clifton
Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity
Am. J. Clinical Nutrition, March 1, 2008; 87(3): 567 - 576.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
Y. M. Smulders, A. Thijs, and J. W. Twisk
New cardiovascular risk determinants do exist and are clinically useful
Eur. Heart J., February 2, 2008; 29(4): 436 - 440.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
A. Philpott and T. J. Anderson
Reactive Hyperemia and Cardiovascular Risk
Arterioscler. Thromb. Vasc. Biol., October 1, 2007; 27(10): 2065 - 2067.
[Full Text] [PDF]


Home page
CirculationHome page
R. Schnabel and S. Blankenberg
Oxidative Stress in Cardiovascular Disease: Successful Translation From Bench to Bedside?
Circulation, September 18, 2007; 116(12): 1338 - 1340.
[Full Text] [PDF]


Home page
J. Am. Coll. Nutr.Home page
S. M. Shenouda and J. A. Vita
Effects of Flavonoid-Containing Beverages and EGCG on Endothelial Function
J. Am. Coll. Nutr., August 1, 2007; 26(4): 366S - 372S.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
T. J. Anderson
Prognostic Significance of Brachial Flow-Mediated Vasodilation
Circulation, May 8, 2007; 115(18): 2373 - 2375.
[Full Text] [PDF]