on May 27, 2003
Published online before print May 27, 2003, doi: 10.1161/01.CIR.0000072765.93106.EE
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Submitted on December 3, 2002
From the Division of Community Internal Medicine (P.V.T.) and the Division of Cardiovascular Diseases (P.O.B., G.M.P., S.T.H., D.R.H., A.L.), Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn. * To whom correspondence should be addressed. E-mail: lerman.amir{at}mayo.edu.
Background--Stroke, mainly attributable to atherothrombotic disease, represents a leading cause of disability and death in the Western world. Endothelial dysfunction, which is considered a key factor in atherogenesis, is associated with an increased risk of cardiovascular events. However, the magnitude of the association between coronary endothelial dysfunction (CED) and cerebrovascular events is unknown. This study was performed to investigate the association between CED and cerebrovascular events. Methods and Results--We studied 503 patients without obstructive coronary artery disease (CAD) who underwent coronary endothelial function testing by intracoronary acetylcholine infusion. Patients were divided according to the presence (n=305) or absence (n=198) of CED, and medical records were examined for the occurrence of ischemic or hemorrhagic stroke or transient ischemic attack either before (prevalent) or after (incident) coronary endothelial function testing. Among the study population, a total of 25 cerebrovascular events were documented, 22 in patients with CED (15 prevalent) and 3 in patients without (all prevalent) (P=0.008). Multivariable logistic regression, which included traditional cerebrovascular disease-related risk factors, identified the presence of CED as the single strongest factor associated with cerebrovascular events (OR, 4.32; 95% CI, 1.26 to 14.83). Kaplan-Meier analysis indicated that patients with CED had a significantly higher cumulative cerebrovascular event rate than those without (P=0.04). Conclusions--Presence of CED in patients without obstructive CAD is independently associated with an increased risk of cerebrovascular events. Thus, detection of this early stage of atherosclerosis may provide important information to identify patients who benefit from aggressive preventive strategies.
Revised on March 17, 2003
Accepted on March 21, 2003
Coronary Endothelial Dysfunction Is Associated With an Increased Risk of Cerebrovascular Events
Paul V. Targonski MD, PhD,
Key words: atherosclerosis • endothelium • epidemiology • risk factors
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Circulation 2003 107: 2766-2768.
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