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Persistent impairment of endothelial vasomotor function has a negative impact on outcome in patients with coronary artery disease.

Abstract：

OBJECTIVES:We assessed the hypothesis that changes in endothelial vasomotor function in response to optimized therapy for atherosclerotic coronary artery disease predict future cardiovascular events. BACKGROUND:Although endothelial vasomotor dysfunction is a predictor of cardiovascular events, it remains unclear whether reversibility of endothelial dysfunction in response to risk factor reduction provides prognostic information. METHODS:This study included 251 patients with newly diagnosed coronary artery disease and an impaired flow-mediated dilation (FMD) of the brachial artery (FMD <5.5%). Measurement of FMD was repeated after 6 months for individualized and optimized therapy to reduce risk factors according to American College of Cardiology/American Heart Association guidelines. Patients were followed up for 36 months or until 1 of the following events occurred: cardiac death, nonfatal myocardial infarction, recurrent and refractory angina pectoris requiring coronary revascularization, or ischemic stroke. RESULTS:FMD was persistently impaired (<5.5%) in 104 (41%) patients after 6 months of optimized therapy, whereas it improved (FMD > or =5.5%) in the remaining 147 (59%) patients. During 36 months of follow-up, events occurred in 27 (26%) patients with persistently impaired FMD and in 15 (10%) patients with improved FMD (p < 0.01 by chi-square test). Multivariate Cox hazards analysis showed that persistent impairment of FMD was an independent predictor of events (hazard ratio: 2.9, 95% confidence interval: 1.5 to 6.2, p < 0.01). Baseline FMD before the optimized therapy to reduce risk factor had no significant prognostic information. CONCLUSIONS:Persistent impairment of endothelial vasomotor function despite optimized therapy to reduce risk factors has an adverse impact on outcome in coronary artery disease patients.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Kitta Y,Obata JE,Nakamura T,Hirano M,Kodama Y,Fujioka D,Saito Y,Kawabata K,Sano K,Kobayashi T,Yano T,Nakamura K,Kugiyama K

doi

10.1016/j.jacc.2008.08.074

subject

Has Abstract

pub_date

2009-01-27 00:00:00

pages

323-30

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(08)03575-4

journal_volume

pub_type

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Persistent impairment of endothelial vasomotor function has a negative impact on outcome in patients with coronary artery disease.