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(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 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 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.

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