Yeboah Joseph, Crouse John R, Hsu Fang-Chi, Burke Gregory L, Herrington David M
Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
Circulation. 2007 May 8;115(18):2390-7. doi: 10.1161/CIRCULATIONAHA.106.678276. Epub 2007 Apr 23.
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.
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 approximately 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 approximately 1% to the accuracy of our best Cox model.
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.
肱动脉血流介导的血管舒张功能（FMD）受损与随后的临床心血管事件之间的关系尚未完全明确，尤其是在FMD常降低的老年人中。我们评估了FMD能否预测基于人群的老年队列中心血管事件的发生这一假设。
在美国4个临床站点招募的2792名年龄在72至98岁的成年人（82.7%为白人，58.6%为女性）中，于1997至1998年心血管健康研究诊所就诊时测量FMD。采用对数秩检验和Cox比例风险模型来检验FMD与经判定的心血管事件之间的关联。在5年随访期内，共有674名受试者（24.1%）发生了经判定的事件。FMD大于性别特异性中位数的受试者心血管事件的无事件生存率显著高于FMD小于或等于性别特异性中位数的受试者（78.3%对73.6%，对数秩检验P = 0.006）。在调整了年龄、性别、糖尿病、吸烟、收缩压和舒张压、基线心血管疾病状态以及总胆固醇后，FMD仍然是心血管事件的显著预测因子（风险比，0.91 [95%可信区间，0.83至0.99]，FMD每单位标准差P = 0.02），但仅使最佳Cox模型的预后准确性提高了约1%。在调整后的Cox比例风险模型中，肱动脉直径也是心血管事件的预测因子（风险比，1.12 [95%可信区间，1.02至1.28]，P = 0.025），并且也使我们最佳Cox模型的准确性提高了约1%。
FMD是未来心血管事件的预测因子，但对老年人传统心血管风险评分/因素的预后准确性提升甚微。FMD和肱动脉直径在老年人心血管事件预测方面可能具有相似的预测价值。
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