Journal
JOURNAL OF THE AMERICAN HEART ASSOCIATION
Volume 7, Issue 14, Pages -Publisher
WILEY
DOI: 10.1161/JAHA.118.008588
Keywords
arterial stiffness; coronary artery disease; endothelial function; flow-induced dilation; pulse wave velocity
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Funding
- Ministry of Education, Science and Culture of Japan [18590815, 21590898]
- Japanese Arteriosclerosis Prevention Fund
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Background-The usefulness of vascular function tests for management of patients with a history of coronary artery disease is not fully known. Methods and Results-We measured flow-mediated vasodilation (FMD) and brachial-ankle pulse wave velocity (baPWV) in 462 patients with coronary artery disease for assessment of the predictive value of FMD and baPWV for future cardiovascular events in a prospective multicenter observational study. The first primary outcome was coronary events, and the second primary outcome was a composite of coronary events, stroke, heart failure, and sudden death. During a median follow-up period of 49.2 months, the first primary outcome occurred in 56 patients and the second primary outcome occurred in 66 patients. FMD above the cutoff value of 7.1%, derived from receiver-operator curve analyses for the first and second primary outcomes, was significantly associated with lower risk of the first (hazard ratio, 0.27; 95% confidence interval, 0.06-0.74; P = 0.008) and second (hazard ratio, 0.32; 95% confidence interval, 0.09-0.79; P = 0.01) primary outcomes. baPWV above the cutoff value of 1731 cm/s was significantly associated with higher risk of the first (hazard ratio, 1.86; 95% confidence interval, 1.01-3.44; P = 0.04) and second (hazard ratio, 2.19; 95% confidence interval, 1.23-3.90; P = 0.008) primary outcomes. Among 4 groups stratified according to the combination of cutoff values of FMD and baPWV, stepwise increases in the calculated risk ratio for the first and second primary outcomes were observed. Conclusions-In patients with coronary artery disease, both FMD and baPWV were significant predictors of cardiovascular events. The combination of FMD and baPWV provided further cardiovascular risk stratification.
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