Marinos Alejandro, Celedonio Jorge E, Ramirez Claudia E, Gottlieb JoAnn, Gamboa Alfredo, Hui Nian, Yu Chang, Stein C Michael, Biaggioni Italo, Shibao Cyndya A
Department of Internal Medicine, William Beaumont Hospital Internal Medicine, Royal Oak, MI (A.M.).
Department of Medicine, Division of Clinical Pharmacology and the Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN (J.E.C., C.E.R., A.G., M.S., I.B., C.A.S.).
J Am Heart Assoc. 2015 Nov 5;4(11):e002388. doi: 10.1161/JAHA.115.002388.
Flow-mediated dilation (FMD) is used to assess endothelial function through changes in vascular diameter after hyperemia. High-fat meal (HFM) has been shown to induce endothelial dysfunction; recent studies, however, reported conflicting results in obese African American women (AAW). Differences in the method used to analyze FMD may explain these discrepancies.
In protocol 1, we assessed the time course of FMD and compared the repeatability of FMD using the individual maximum peak dilation (FMDpeak) and the dilation at 60 seconds (FMD60). Sixteen AAW (age, 42±10.4 years; body mass index [BMI], 39±5.8 kg/m(2)) were studied on 2 occasions, 4 weeks apart, under fasting conditions (study 1 and study 2). In protocol 2, we used the most repeatable measurement from protocol 1 to assess changes in endothelial function after an HFM in 17 AAW (agen 42±11.1 years; BMIn 38±5.6 kg/m(2)). We found that FMDpeak was the most repeatable measurement (N=16; study 1, 5.31±3.12% and study 2, 5.80±2.91%; r=0.94). After an HFM, the baseline brachial artery diameter significantly increased at 2 hours (0.10 mm; 95% confidence interval [CI], 0.01-0.18; P=0.03) and at 4 hours (0.17 mm; 95% CI, 0.09-0.25; P<0.001). At 2 hours, the FMDpeak decreased compared with pre-HFM (-1.76; 95% CI, -3.55-0.02; P≤0.05).
The individual's maximum peak dilation after hyperemia is the most consistent measure to assess the effect of an HFM on endothelial function. Endothelial dysfunction occurred at 2 hours after an HFM in AAW.
URL: https://clinicaltrials.gov/ Unique identifiers: NCT01334554 and NCT02126735.
血流介导的血管舒张（FMD）用于通过充血后血管直径的变化来评估内皮功能。高脂餐（HFM）已被证明可诱发内皮功能障碍；然而，最近的研究在肥胖非裔美国女性（AAW）中报告了相互矛盾的结果。用于分析FMD的方法差异可能解释了这些差异。
在方案1中，我们评估了FMD的时间进程，并使用个体最大峰值扩张（FMDpeak）和60秒时的扩张（FMD60）比较了FMD的可重复性。16名AAW（年龄，42±10.4岁；体重指数[BMI]，39±5.8kg/m²）在禁食条件下分两次进行研究，间隔4周（研究1和研究2）。在方案2中，我们使用方案1中最具可重复性的测量方法来评估17名AAW（年龄42±11.1岁；BMI 38±5.6kg/m²）在高脂餐后内皮功能的变化。我们发现FMDpeak是最具可重复性的测量指标（N = 16；研究1，5.31±3.12%；研究2，5.80±2.91%；r = 0.94）。高脂餐后，肱动脉基线直径在2小时时显著增加（0.10mm；95%置信区间[CI]，0.01 - 0.18；P = 0.03），在4小时时也显著增加（0.17mm；95%CI，0.09 - 0.25；P < 0.001）。在2小时时，FMDpeak与高脂餐前相比下降（-1.76；95%CI，-3.55 - 0.02；P≤0.05）。
充血后个体的最大峰值扩张是评估高脂餐对内皮功能影响的最一致指标。AAW在高脂餐后2小时出现内皮功能障碍。
网址：https://clinicaltrials.gov/ 唯一标识符：NCT01334554和NCT02126735。
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