Endothelial Dysfunction, Increased Arterial Stiffness, and Cardiovascular Risk Prediction in Patients With Coronary Artery Disease: FMD‐J (Flow‐Mediated Dilation Japan) Study A

Abstract

BackgroundThe usefulness of vascular function tests for management of patients with a history of coronary artery disease is not fully known.Methods and ResultsWe measured flow‐mediated vasodilation (FMD) and brachial–ankle pulse wave velocity (baPWV) in 462 patients with coronary artery disease for assessment of the predictive value of FMD and baPWV for future cardiovascular events in a prospective multicenter observational study. The first primary outcome was coronary events, and the second primary outcome was a composite of coronary events, stroke, heart failure, and sudden death. During a median follow‐up period of 49.2 months, the first primary outcome occurred in 56 patients and the second primary outcome occurred in 66 patients. FMD above the cutoff value of 7.1%, derived from receiver‐operator curve analyses for the first and second primary outcomes, was significantly associated with lower risk of the first (hazard ratio, 0.27; 95% confidence interval, 0.06–0.74; P=0.008) and second (hazard ratio, 0.32; 95% confidence interval, 0.09–0.79; P=0.01) primary outcomes. baPWV above the cutoff value of 1731 cm/s was significantly associated with higher risk of the first (hazard ratio, 1.86; 95% confidence interval, 1.01–3.44; P=0.04) and second (hazard ratio, 2.19; 95% confidence interval, 1.23–3.90; P=0.008) primary outcomes. Among 4 groups stratified according to the combination of cutoff values of FMD and baPWV, stepwise increases in the calculated risk ratio for the first and second primary outcomes were observed.ConclusionsIn patients with coronary artery disease, both FMD and baPWV were significant predictors of cardiovascular events. The combination of FMD and baPWV provided further cardiovascular risk stratification.Clinical Trial Registration URL: http://www.umin.ac.jp. Unique identifier: UMIN000012950.

Target of Triglycerides as Residual Risk for Cardiovascular Events in Patients With Coronary Artery Disease ― Post Hoc Analysis of the FMD-J Study A ―

“…An independent clinical-events committee adjudicated the endpoints of death from CV causes, nonfatal acute coronary syndrome (ACS), nonfatal stroke, CAD, hospitalization for heart failure, and death from any cause. 17,18 CAD was defined as coronary artery restenosis or de novo coronary artery stenosis, confirmed by diagnostic imaging (coronary angiography, cardiac nuclear scintigraphy, or coronary computed tomography). Definitions of the clinical outcomes have been provided previously.…”

“…Definitions of the clinical outcomes have been provided previously. 17,18 The committee, consisting of members blinded to any information with regard to blood samples, assessed the appropriateness of clinical judgements of CV events according to prespecified criteria. The committee could request physicians to provide additional clinical information on CV events if needed.…”

“…The rationale and design of the FMD-J Study A have been described previously. 17,18 It was a prospective multicenter observational cohort study conducted at 22 university hospitals and affiliated clinics in Japan to examine the usefulness of flow-mediated vasodilation assessment for the management of patients with CAD with a 3-year follow-up period. 17,18 The study was approved by the ethical committee of each institute and was executed in accordance with the Good Clinical Practice guidelines.…”

East Asians Variant Mitochondrial Aldehyde Dehydrogenase 2 Genotype Exacerbates Nitrate Tolerance in Patients With Coronary Spastic Angina

“…Reduced FMD and GTN tolerance were reported to be significant predictors of cardiovascular events. 29,35,36 The results of the present study thus suggest that continuous administration of organic nitrates, including GTN, should be avoided as much as possible, particularly in those with ALDH2*2. Indeed, recent studies reported that adverse cardiac events occurred on chronic nitrate treatment in patients with CAD including CSA.…”

<p>Endothelial Function in Obese Patients Treated with Bariatric Surgery</p>

“…12 A large body of evidence has demonstrated that low FMD strongly predicts CV events. 13 To date, only few studies have investigated the effects of BS on endothelial function in terms of FMD demonstrating in general that FMD improves after BS. 14 However, some controversial results have also been reported and some studies have failed to confirm these conclusions.…”