The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort

Background: Brachial artery flow-mediated dilation (FMD) may predict cardiovascular events in selected high-risk patients. Whether FMD testing predicts cardiovascular events in asymptomatic, lower risk individuals from the general population is unknown. Methods and results: As a part of a multi-ethnic, prospective cohort study, the Northern Manhattan Study, we examined FMD by high-resolution ultrasonography in 842 community participants who were free of stroke or myocardial infarction. Lower FMD levels predicted cardiovascular events (myocardial infarction, stroke and vascular death) at 36 months of follow-up (hazard ratio (HR) = 1.12 for every 1% decrease in FMD, 95% CI 1.01-1.25, p = 0.03). The risk of events in patients with FMD in the lower two tertiles (FMD < 7.5%) was significantly higher than those in the highest tertile (HR = 3.28, 95% CI 1.07-10.06, p = 0.04 for lowest versus highest tertile, and HR = 3.05, 95% CI 1.03-9.66, p = 0.04 for middle versus highest tertile). In a multivariate analysis including cardiovascular risk factors, the increase in risk associated with FMD was no longer statistically significant. Conclusions: Non-invasive FMD testing predicts incident cardiovascular events in this multi-ethnic, population-based sample, but its predictive value is not independent of cardiovascular risk factors. (c) 2006 Elsevier Ireland Ltd. All rights reserved.