Rossi Rosario, Nuzzo Annachiara, Origliani Giorgia, Modena Maria Grazia
Institute of Cardiology, Policlinico Hospital, University of Modena and Reggio Emilia, Modena, Italy.
J Am Coll Cardiol. 2008 Mar 11;51(10):997-1002. doi: 10.1016/j.jacc.2007.11.044.
The aim of this study was to examine the association between brachial artery flow-mediated dilation (FMD) and cardiovascular events in a cohort of initially asymptomatic post-menopausal women, with adjustment for the presence of the major cardiovascular risk factors.
Conventional major cardiovascular risk factors (cigarette smoking, hypercholesterolemia, hypertension, and diabetes) fail to explain nearly 50% of cardiovascular events. Defining the magnitude of future risk for the development of clinical events is a major focus of effective primary prevention. Evaluation of endothelial function, utilizing the noninvasive measurement of the brachial artery FMD, may serve as a screening tool to individualize high-risk patients.
We conducted a prospective study on 2,264 post-menopausal women, age 54 +/- 6 years. The length of the follow-up was 45 +/- 13 months (range 6 to 65 months).
During observation, 90 major events were recorded. Risk-adjusted relative risk values resulted 1.0, 1.33 (95% confidence interval [CI] 1.09 to 4.09), and 4.42 (95% CI 2.97 to 8.01) for women in the higher, intermediate, and lower tertile of FMD, respectively (p < 0.0001 for trend). The event rate for women in the lower tertile (FMD <or=4.5%) was greater than the combined event rate noted in the other 2 tertiles (women in the lower tertile accounted for 51 events [56.6% of total events]). When added to age and other conventional cardiovascular risk factors (smoking habits, presence of hypercholesterolemia, history of diabetes, hypertension), FMD contributed significantly to the model predicting cardiovascular events (likelihood ratio chi-square change: 10.22; p < 0.0001).
In post-menopausal women, the knowledge of FMD provided incremental prognostic information regarding the risk of developing cardiovascular events.
本研究旨在探讨在一组最初无症状的绝经后女性队列中，肱动脉血流介导的血管舒张功能（FMD）与心血管事件之间的关联，并对主要心血管危险因素的存在情况进行校正。
传统的主要心血管危险因素（吸烟、高胆固醇血症、高血压和糖尿病）无法解释近50%的心血管事件。确定临床事件发生的未来风险程度是有效一级预防的主要重点。利用肱动脉FMD的无创测量来评估内皮功能，可作为一种筛选工具，用于个体化高危患者。
我们对2264名年龄在54±6岁的绝经后女性进行了一项前瞻性研究。随访时间为45±13个月（范围6至65个月）。
在观察期间，记录了90例主要事件。FMD处于较高、中等和较低三分位数的女性，风险调整后的相对风险值分别为1.0、1.33（95%置信区间[CI]为1.09至4.09）和4.42（95%CI为2.97至8.01）（趋势p<0.0001）。较低三分位数（FMD≤4.5%）女性的事件发生率高于其他两个三分位数女性的合并事件发生率（较低三分位数的女性占51例事件[占总事件的56.6%]）。当将FMD添加到年龄和其他传统心血管危险因素（吸烟习惯、高胆固醇血症的存在、糖尿病史、高血压）中时，FMD对预测心血管事件的模型有显著贡献（似然比卡方变化：10.22；p<0.0001）。
在绝经后女性中，FMD的信息为发生心血管事件的风险提供了额外的预后信息。
