The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes

A Multicenter Study Design to Assess the Clinical Usefulness of Semi-Automatic Measurement of Flow-Mediated Vasodilatation of the Brachial Artery

“…Thus, the present FMDJ study may clarify the usefulness of FMD for cardiovascular risk assessment in all stages on the cardiovascular continuum. 1,2) However, a limitation of the present study is that the sublingual administration of nitroglycerin is not included in the protocol, and therefore, we cannot fully examine endotheliumdependent vasodilatation. Conclusions : We believe that the current FMDJ study will provide important evidence for the application of FMD as an independent marker in the risk stratification and predictor of cardiovascular disease.…”

“…1,2) Abnormal endothelial nitric oxide (NO) bioavailability is known to be closely involved in the progression of vascular or organ damage, and this abnormality is thought to be one of the important factors in the progression of pathological abnormalities, not only in the early stages, but also in the advanced stages in the cardiovascular disease continuum. 1,2) The flow-mediated vasodilatation of the brachial artery (FMD) is known as a marker which is related to endothelial NO bioavailability. 3,4) Therefore, several studies have suggested the usefulness of FMD measurement in the risk Vol 53 No 3 ENDOTHELIAL FUNCTION AND PROGNOSIS stratification for cardiovascular disease in all stages on the cardiovascular disease continuum.…”

“…3,4) Therefore, several studies have suggested the usefulness of FMD measurement in the risk Vol 53 No 3 ENDOTHELIAL FUNCTION AND PROGNOSIS stratification for cardiovascular disease in all stages on the cardiovascular disease continuum. 1,2,4,5) Study aims: The present multicenter prospective study has 1 primary objective: to establish the usefulness of FMD as measured by online semi-automatic software (usually a dedicated device for FMD measurement) in the risk stratification for cardiovascular diseases in Japanese subjects. In addition, there are 4 proposed secondary objectives, as follows: 1) to establish standardized FMD values and the annual rates of FMD change in healthy subjects, and also examine whether the development of the conventional risk factors for cardiovascular disease might modulate the annual rates of FMD change; 2) to assess the predictive value of FMD for future cardiovascular events in Japanese subjects with coronary artery disease (CAD), independent of the conventional risk factors for cardiovascular disease; 6) 3) to evaluate the usefulness of a multimarker strategy, including measurements of FMD, pulse-wave velocity (PWV), 7) ankle-brachial pressure index (ABI), biochemical markers (serum C-reactive protein [CRP], oxidized low-density lipoprotein cholesterol, and plasma B-type natriuretic peptide [BNP] levels) 8) and a proteomic biomarker 9) identified by mass-spectroscopic analysis, to assess the prognosis of Japanese subjects with CAD; and 4) to clarify whether FMD might serve as a reliable predictor of the rate of progression of carotid atherosclerosis, 10) arterial stiffness and microalbuminuria in subjects with hypertension or diabetes mellitus, independent of the biochemical and proteomic biomarkers.…”

Hypertension and heart failure: a dysfunction of systole, diastole or both?

“…This cardiovascular disease continuum, by which common and overlapping pathophysiological mechanisms are involved in multiple steps in disease development across the entire spectrum of cardiovascular disease as well as diseases of other target organs, including the brain and kidneys, has received experimental and clinical validation, with an increasing recognition of the important roles of oxidative stress and nitric oxide synthase, metalloproteinases and their inhibitors, renin-angiotensin-aldosterone system and sympathetic nervous system, in the development of heart failure. [2][3][4][5] A number of primary prevention trials demonstrated that treating hypertension can reduce the development of heart failure up to 50%. In patients with left ventricular systolic dysfunction 6 or LVH, control of blood pressure prevents or retards ventricular remodelling and decreases the incidence of overt heart failure.…”

Rationale and design of the KYOTO HEART study: effects of valsartan on morbidity and mortality in uncontrolled hypertensive patients with high risk of cardiovascular events

“…14 It is beyond the scope of this introduction to review all the studies showing beneficial effects on cardiovascular outcomes from blocking the RAS, in particular with ARBs, in various stages of the cardiovascular continuum. 15 It is important though to point out that all these studies with a few exceptions have included at maximum a few percentage of Asian patients in general and very few Japanese patients in particular.…”