@article {806, title = {Racial differences in endothelial function in postmenopausal women.}, journal = {Am Heart J}, volume = {148}, year = {2004}, month = {2004 Oct}, pages = {606-11}, abstract = {

OBJECTIVE: Racial differences in cardiovascular mortality among women remain largely unexplained. Preliminary data suggest that African American and Caucasian differences in endothelial function may parallel differential cardiovascular disease (CVD) risk in women. To further study differences in endothelial function between African American and Caucasian women, we analyzed measures of brachial artery flow-mediated dilation (FMD) in women enrolled in the Cardiovascular Health Study (CHS).

METHODS AND RESULTS: Brachial artery FMD was measured in the fasting state using established ultrasound techniques in 1330 Caucasian and 297 African American female participants in CHS (mean age 78.4 +/- 4.4 years). General linear models were used to compare FMD between African American and Caucasian women after adjusting for baseline brachial diameter, hypertension, diabetes, smoking, cholesterol, systolic blood pressure, body mass index, waist/hip ratio, age, education, income level; use of angiotensin-converting enzyme inhibitors, beta-blockers, nitroglycerin, estrogens and lipid-lowering drugs; and presence of clinical or subclinical disease. Adjusted absolute change and percent change in brachial artery diameter was significantly reduced in African American women compared with Caucasian women (P <.0001 and P =.0002, respectively). Similar results were found when the women were stratified by history of CVD (- CVD, P =.02; + CVD, P =.001) and CVD or subclinical vascular disease (- disease, P =.01, + disease, P =.03).

CONCLUSIONS: In this cohort, brachial artery FMD was lower in African American women compared to Caucasian women, and this difference persisted after adjustment by multivariable analysis. The increased CVD risk in African American women may be related to impaired endothelial function. It remains to be determined whether African American women may uniquely benefit by interventions designed to improve endothelial health.

}, keywords = {African Continental Ancestry Group, Aged, Brachial Artery, Cohort Studies, Endothelium, Vascular, European Continental Ancestry Group, Female, Humans, Multivariate Analysis, Postmenopause, Risk Factors, Vasodilation}, issn = {1097-6744}, doi = {10.1016/j.ahj.2004.04.032}, author = {Loehr, Laura R and Espeland, Mark A and Sutton-Tyrrell, Kim and Burke, Gregory L and Crouse, John R and Herrington, David M} } @article {962, title = {Brachial flow-mediated dilation predicts incident cardiovascular events in older adults: the Cardiovascular Health Study.}, journal = {Circulation}, volume = {115}, year = {2007}, month = {2007 May 08}, pages = {2390-7}, abstract = {

BACKGROUND: The relationship between impaired brachial flow-mediated dilation (FMD) and subsequent clinical cardiovascular events is not well established, especially in older adults whose FMD is often diminished. We assessed the hypothesis that FMD predicts incident cardiovascular events in a population-based cohort of older adults.

METHODS AND RESULTS: FMD was measured at the 1997 to 1998 Cardiovascular Health Study clinic visit in 2792 adults aged 72 to 98 years (82.7\% white, 58.6\% women) recruited at 4 clinic sites in the United States. Log-rank test and Cox proportional hazard models were used to examine the association between FMD and adjudicated cardiovascular events. A total of 674 subjects (24.1\%) had an adjudicated event over the 5-year follow-up period. Event-free survival rates for cardiovascular events were significantly higher in subjects with FMD greater than the sex-specific medians than in subjects with FMD less than or equal to the sex-specific medians (78.3\% versus 73.6\%, log-rank P=0.006). FMD remained a significant predictor of cardiovascular events after adjustment for age, gender, diabetes mellitus, cigarette smoking, systolic and diastolic blood pressure, baseline cardiovascular disease status, and total cholesterol (hazard ratio, 0.91 [95\% CI, 0.83 to 0.99], P=0.02 per unit SD of FMD) but added only approximately 1\% to the prognostic accuracy of the best Cox model. Brachial artery diameter was also predictive of CV events in the adjusted Cox proportional hazard model (hazard ratio, 1.12 [95\% CI, 1.02 to 1.28], P=0.025) and also added approximately 1\% to the accuracy of our best Cox model.

CONCLUSIONS: FMD is a predictor of future cardiovascular events but adds very little to the prognostic accuracy of traditional cardiovascular risk scores/factors in older adults. FMD and brachial artery diameter may have similar predictive values for cardiovascular events in older adults.

}, keywords = {Aged, Aged, 80 and over, Atherosclerosis, Biomarkers, Brachial Artery, Cardiovascular Diseases, Cohort Studies, Disease-Free Survival, Endothelium, Vascular, Female, Hemorheology, Humans, Hyperemia, Male, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Prospective Studies, Reproducibility of Results, Risk Factors, Stress, Mechanical, Tourniquets, Ultrasonography, United States, Vasodilation}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.106.678276}, author = {Yeboah, Joseph and Crouse, John R and Hsu, Fang-Chi and Burke, Gregory L and Herrington, David M} } @article {976, title = {Association between brachial artery reactivity and cardiovascular disease status in an elderly cohort: the cardiovascular health study.}, journal = {Atherosclerosis}, volume = {197}, year = {2008}, month = {2008 Apr}, pages = {768-76}, abstract = {

BACKGROUND AND OBJECTIVES: The association of brachial flow-mediated dilation (FMD) and cardiovascular disease (CVD) status is unclear especially in older adults whose FMD is greatly diminished. We assessed the association of FMD and the presence or absence of subclinical and clinical CVD in a population based cohort of older adults.

METHODS AND RESULTS: FMD was measured in 2971 adults aged 72-98 years (mean age 78.6 years) who participated in the Cardiovascular Health Study. Multiple linear regression analysis was used to examine the association between FMD and CVD status (clinical, subclinical and free of CVD). Out of 2791 with complete data, 82.7\% were Caucasians and 59\% females. Seven hundred and forty-three were classified as having clinical CVD, 607 as subclinical CVD and 1441 as neither clinical CVD nor subclinical CVD (CVD free). FMD was higher in the CVD free group compared with either the clinical (3.13+/-0.05\% vs 2.93+/-0.07\%, p=0.025) or the subclinical CVD group (3.13+/-0.05\% vs 2.95+/-0.08\%, p=0.05) after adjusting for covariates. There was no significant difference between the FMD of subjects with clinical and subclinical CVD (2.93+/-0.07\% vs 2.95+/-0.08\%, p=0.84). Similar but inverted associations were observed between height adjusted brachial artery diameter (BAD) and CVD status. However, FMD and BAD had poor diagnostic accuracies for identifying older adults with subclinical CVD.

CONCLUSION: Among older adults, those with either clinical or subclinical CVD have lower FMD than CVD free subjects. BAD showed similar but inverted associations with CVD status in this cohort. FMD and BAD had poor diagnostic accuracies for identifying older adults with subclinical CVD.

}, keywords = {Aged, Aged, 80 and over, Biomarkers, Brachial Artery, Cardiovascular Diseases, Cohort Studies, Female, Hemorheology, Humans, Male, Peripheral Vascular Diseases, ROC Curve, Ultrasonography, Vasodilation}, issn = {1879-1484}, doi = {10.1016/j.atherosclerosis.2007.07.013}, author = {Yeboah, Joseph and Sutton-Tyrrell, Kim and McBurnie, Mary Ann and Burke, Gregory L and Herrington, David M and Crouse, John R} } @article {980, title = {Relationship between brachial flow-mediated dilation and carotid intima-media thickness in an elderly cohort: the Cardiovascular Health Study.}, journal = {Atherosclerosis}, volume = {197}, year = {2008}, month = {2008 Apr}, pages = {840-5}, abstract = {

OBJECTIVE: The aim of this study was to determine the relationship between brachial flow-mediated dilation (FMD) and carotid intima-media thickness (IMT) in a large multi-ethnic elderly cohort.

BACKGROUND: Brachial flow-mediated dilation (FMD) is a physiologic measure and carotid IMT is an anatomic structural measure of subclinical atherosclerosis. Both brachial FMD and carotid IMT have been associated with cardiovascular risk factors and cardiovascular events. The relationship between brachial FMD and carotid IMT is less clear especially in older adults.

METHODS: Brachial FMD, carotid IMT and traditional cardiovascular risk factors were measured in 2338 adults, age 72-98 years who were participants in the Cardiovascular Health Study. The relationship between FMD and IMT was assessed both unadjusted and also after adjusting for age, gender and race/ethnicity, BMI, HDL, LDL, systolic and diastolic blood pressure, serum creatinine, current smoking, diabetes mellitus, hormone therapy and prior CVD.

RESULTS: Both brachial FMD and carotid IMT correlated significantly with age, HDL levels, waist/hip ratio, serum cholesterol and number of CV risk factors. Brachial FMD was not associated with CCA IMT in this elderly cohort (Pearson partial correlation coefficient=-0.0252, p=0.222). In the adjusted linear regression model with CCA IMT as the dependent variable, brachial FMD was also not associated with CCA IMT (beta coefficient=-0.006, p=0.470).

CONCLUSION: Brachial FMD and CCA IMT are not related in population-based older adults. Brachial FMD and CCA IMT may be distinct and independent stages in the complex atherosclerotic process.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Brachial Artery, Carotid Arteries, Carotid Artery Diseases, Cohort Studies, Female, Hemorheology, Humans, Male, Tunica Intima, Tunica Media, Ultrasonography, Vasodilation}, issn = {1879-1484}, doi = {10.1016/j.atherosclerosis.2007.07.032}, author = {Yeboah, Joseph and Burke, Gregory L and Crouse, John R and Herrington, David M} }