Predictive Value of Brachial Flow-Mediated Dilation for Incident Cardiovascular Events in a Population-Based Study: The Multi-Ethnic Study of Atherosclerosis
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Background— Although brachial artery flow-mediated dilation (FMD) predicts recurrent cardiovascular events, its predictive value for incident cardiovascular disease (CVD) events in adults free of CVD is not well established. We assessed the predictive value of FMD for incident CVD events in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods and Results— Brachial artery FMD was measured in a nested case-cohort sample of 3026 of 6814 subjects (mean±SD age, 61.2±9.9 years) in MESA, a population-based cohort study of adults free of clinical CVD at baseline recruited at 6 clinic sites in the United States. The sample included 50.2% female, 34.3% white, 19.7% Chinese, 20.8% black, and 25.1% Hispanic subjects. Probability-weighted Cox proportional hazards analysis was used to examine the association between FMD and 5 years of adjudicated incident CVD events, including incident myocardial infarction, definite angina, coronary revascularization (coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, or other revascularization), stroke, resuscitated cardiac arrest, and CVD death. Mean (SD) FMD of the cohort was 4.4% (2.8). In probability-weighted Cox models, FMD/unit SD was significantly associated with incident cardiovascular events in the univariate model (adjusted for age and sex) (hazard ratio, 0.79; 95% confidence interval, 0.65 to 0.97; P =0.01), after adjustment for the Framingham Risk Score (FRS) (hazard ratio, 0.80; 95% confidence interval, 0.62 to 0.97; P =0.025), and in the multivariable model (hazard ratio, 0.84; 95% confidence interval, 0.71 to 0.99; P =0.04) after adjustment for age, sex, diabetes mellitus, cigarette smoking status, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, heart rate, statin use, and blood pressure medication use. The c statistic (area under the curve) values of FMD, FRS, and FRS+FMD were 0.65, 0.74, and 0.74, respectively. Compared with the FRS alone, the addition of FMD to the FRS net correctly reclassifies 52% of subjects with no incident CVD event but net incorrectly reclassifies 23% of subjects with an incident CVD event, an overall net correct reclassification of 29% ( P <0.001). Conclusions— Brachial FMD is a predictor of incident cardiovascular events in population-based adults. Even though the addition of FMD to the FRS did not improve discrimination of subjects at risk of CVD events in receiver operating characteristic analysis, it improved the classification of subjects as low, intermediate, and high CVD risk compared with the FRS.
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Each 0.66 SD in FMD is associated with an 18% higher risk of composite cardiovascular events and a 36% higher risk of myocardial infarction, resuscitated cardiac arrest, or death from coronary heart disease.
“Similar results were seen in another population-based study wherein each 0.66 standard deviation in FMD was associated with an 18% increased risk of composite cardiovascular events and 36% increase risk of myocardial infarction, resuscitated cardiac arrest or coronary heart disease death [23].”
From One-day acceptance and commitment therapy (ACT) workshop improves anxiety but not vascular function or inflammation in adults with moderate to high anxiety levels in a randomized controlled trial. (2021) · cites this paper as [23]
The Results report an inverse association between FMD and cardiovascular events, and the Methods and Results summary gives a fully adjusted hazard ratio of 0.84 per one SD higher FMD—approximately 19% higher risk in the opposite direction. But that summary defines the SD as 2.8 percentage points of FMD, not 0.66 SD. The Results also report associations with MI and cardiovascular death, but the available passages do not substantiate a 36% increase for the specified coronary-event composite. (LLM, conf=0.87)
Experimental — accuracy not yet measuredAn impairment in flow-mediated dilation is an indicator of future possible risk of cardiovascular disease.
“An impairment in FMD is an indicator of future possible risk of CVD (39).”
From Oral inflammatory load predicts vascular function in a young adult population: a pilot study (2023) · cites this paper as [39]
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- Authors
- Yeboah, J., Folsom, A. R., Burke, G. L., Johnson, C., Polak, J. F., Post, W., Lima, J. A., Crouse, J. R., & Herrington, D. M.
- Affiliations
- University of Minnesota (US)
- From the Department of Internal Medicine/Cardiology, University of Virginia School of Medicine, Charlottesville (J.Y.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis (A.R.F.); Department of Internal Medicine/Cardiology and the Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (G.L.B., J.R.C., D.M.H.); Collaborative Health Studies Coordinating Center, University of Washington, Seattle (C.J.); Department of Radiology,...
- ORCID
- Venue
- Circulation
- Published
- 2009-08-11
- Volume
- 120
- Issue
- 6
- Pages
- 502-509
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- PMC
- PMC2740975
- OpenAlex
- W2122880159
- Cited by
- 888
- References
- 27
- Citations by year
- 2026: 18 · 2025: 30 · 2024: 24 · 2023: 38 · 2022: 48 · 2021: 48 · 2020: 61 · 2019: 53 · 2018: 56 · 2017: 43 · 2016: 70 · 2015: 69 · 2014: 68 · 2013: 64 · 2012: 78
- FWCI
- 42.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01hc095169-003, n01hc95166-21-0-1, n01hc95159-40-0-1)
- National Heart, Lung, and Blood Institute (N01 HC-95159, N01-HC095169, N01-HC-095159, N01 HC095166, N01‐HC‐95166, N01-HC-95159 through N01-HC-95166, T32HL076132, N01 HC95169)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- flow-mediated dilation, brachial artery, incident cardiovascular events, cardiovascular risk prediction, Framingham risk score, myocardial infarction, stroke, coronary revascularization, cardiovascular mortality, Multi-Ethnic Study of Atherosclerosis, endothelial function, risk stratification, concordance index, risk prediction model, statin use, blood pressure
- MeSH terms
- Aged, Aged, 80 and over, Asian, Brachial Artery, Female, Follow-Up Studies, Hispanic or Latino, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Regional Blood Flow, Vasodilation, Cohort Studies, Biomarkers, Incidence, Prevalence, Multivariate Analysis, Proportional Hazards Models, Case-Control Studies, Black People, White People, Atherosclerosis
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