Combined use of endothelial function assessed by brachial ultrasound and high‐sensitive C‐reactive protein in predicting cardiovascular events

Abstract

SummaryBackground: Endothelial function plays a key role in determining the clinical manifestations of atherosclerotic lesions. Elevated high-sensitive C-reactive protein (hsCRP) relates to long-term prognosis of cardiovascular disease.Hypothesis: We test the hypothesis that combined use of endothelial function and hsCRP could increase predictive value of future cardiovascular events.Methods and Results: 205 patients were followed up for a median period of 24 months. Endothelial function was assessed using brachial ultrasound to measure endothelium-dependent flow-mediated vasodilation (FMD). Cox regression analyses were conducted for the 205 subjects, with cardiovascular events being defined as myocardial infarction, hospitalization due to congestive heart failure, percutaneous coronary intervention, coronary artery bypass grafting, and ischemic stroke. Twenty nine (14%) developed cardiovascular events. Both FMD and hsCRP were significantly predictive of cardiovascular events (relative risk for patients with FMD < 3% as compared to those with FMD

Plasma levels of soluble receptor for advanced glycation end products are associated with endothelial function and predict cardiovascular events in nondiabetic patients

“…Endothelial dysfunction, an early sign of vascular injury, is characterized by a reduction of the bioavailability of vasodilators, particularly nitric oxide [12]. The loss of intact endothelial integrity and function sets in motion a cascade of serial events that lead to atherosclerosis and cardiovascular complications [13]. However, clinical data regarding the relationship between sRAGE and endothelial function are lacking and it is not known whether plasma sRAGE levels can predict cardiovascular events.…”

Perfil glicometabólico inicial em pacientes com síndrome coronariana aguda e síndrome metabólica

“…In patients with MetS, inflammatory stimuli can cause an additional imbalance between NO production and endothelin-1 secretion, leading to reduced blood flow and impaired glucose uptake in peripheral muscle 17 . In addition, endothelial dysfunction has been related to the development of atherosclerosis and cardiovascular events 18,19 .…”

Valor prognóstico da função endotelial em portadores de aterosclerose: revisão sistemática

“…A significant worsening in event-free survival in 36 months has been observed in the group of FMV < 6% combined with hsCRP ≥ 1 mg/dL, as compared with each one alone and with the combination of FMV ≥ 6% and hsCRP < 1 mg/dL. While the RR for the group of FMV ≥ 6% and hsCRP ≥ 1 mg/dL was 3.36, for the group of FMV < 6% and hsCRP ≥ 1 mg/dL, RR increased to 12.5 (p = 0.014) 15 .…”

“…In some situations, variables, such as diabetes and other classical risk factors, should be included due to biological plausibility and previous evidence. It is worth citing the study by Huang et al 15 about CAD, which, on multivariate analysis, has adjusted only for the co-variables significantly related to the cardiovascular events of univariate analysis [age, hypertension, FMV and high-sensitivity C-reactive protein (hsCRP)], and the study by Brevetti et al 16 about PAD [dyslipidemia, hypertension, previous stroke, ankle-brachial index (ABI) and FMV]. So far, no adjustment for a complete model, such as the Framingham and GRACE scores, has been detected in a more representative form in any of the analyses performed.…”