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Cited by 326

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The prognostic importance of endothelial dysfunction and carotid atheromaburden in patients with coronary artery disease

Open access
Chan, Sammy Y, Mancini, G.B.John, Kuramoto, Lisa, Schulzer, Michael, Frohlich, Jiri, Ignaszewski, Andrew·2003·Journal of the American College of Cardiology

Abstract

OBJECTIVES The goal of this study was to determine the relative prognostic importance of noninvasive measures of endothelial function and atheroma burden in patients with coronary artery disease (CAD). BACKGROUND Direct measurement of atherosclerosis by carotid ultrasound and endothelial function assessment by brachial artery flow-mediated dilation (FMD) have both been shown to predict vascular events. The combined prognostic utility of carotid ultrasound and FMD relative to traditional risk markers and cardiovascular fitness has not been evaluated. METHODS A total of 152 patients with CAD underwent metabolic testing, exercise stress tests, carotid ultrasound, and endothelial function measurements. RESULTS Patients were followed for 34 +/- 10 months during which 22 vascular events occurred. Peak FMD (p = 0.012) and FMD/nitroglycerin-mediated dilation (NMD) ratio (p = 0.008) were lower in subjects with events. Univariate analysis with Cox proportional hazards modeling identified plaque area (p = 0.0047), total area (p = 0.0085), peak FMD (p = 0.01), FMD/NMD ratio (p = 0.008), stress test workload (p = 0.027), long-acting nitroglycerin (NTG) (p = 0.0071), and calcium blockers (p = 0.0057) as predictors of adverse events. Multivariate analysis showed that FMD/NMD ratio (p < 0.0001), carotid plaque area (p = 0.06), and NTG (p = 0.005) were independent predictors. Based on median values, subjects were divided into high and low "plaque burden" groups and into high and low FMD/NMD subgroups. Patients with high FMD/NMD had low event rates irrespective of the degree of carotid atheroma. Patients with low FMD/NMD and high "plaque burden" had the highest event rate (p < 0.05). CONCLUSIONS The structural and functional status of the vasculature are independent predictors of coronary events as shown by noninvasive measurement of endothelial function and carotid atheroma burden in patients with CAD. Preserved endothelial function attenuates the risk of future events associated with a high plaque burden.

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Metadata

Authors
Chan, S. Y., Mancini, G. B. J., Kuramoto, L., Schulzer, M., Frohlich, J., & Ignaszewski, A.
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2003-09
Volume
42
Issue
6
Pages
1037-1043
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2049175271
Cited by
326
References
33
FWCI
12.57
Type
journal article
Language
en
Open access
bronze

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CoChat. (2026). Citation check: The prognostic importance of endothelial dysfunction and carotid atheromaburden in patients with coronary artery disease. https://app.cochat.ai/papers/10.1016/s0735-1097(03)00927-6
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Chan, S. Y., Mancini, G. B. J., Kuramoto, L., Schulzer, M., Frohlich, J., & Ignaszewski, A. (2003). The prognostic importance of endothelial dysfunction and carotid atheromaburden in patients with coronary artery disease. Journal of the American College of Cardiology. https://doi.org/10.1016/s0735-1097(03)00927-6

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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