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

Abstract

Analysis of flow-mediated vasodilation (FMV) of the brachial artery by use of ultrasound allows assessing endothelial function, and provides pathophysiological, diagnostic and prognostic information.This systematic review was aimed at assessing the literature level of evidence of the predictive capacity of endothelial function, measured through brachial artery FMV by use of ultrasound, regarding cardiovascular events in individuals with atherosclerosis.The MEDLINE, SCIELO and LILACS databases were searched, and prospective cohort studies on human beings about the prognostic value of endothelial function, measured by use of brachial artery FMV in individuals with peripheral or coronary atherosclerosis, were selected. Studies with clear methodological biases were excluded.The final selection consisted of 15 studies. Of the 13 studies that on univariate analysis showed statistical significance of the FMV method to predict cardiovascular events, 12 showed independent predictive capacity on multivariate analysis. None of the studies reviewed described the incremental predictive value of FMV to the traditional predictive models, such as the Framingham score. Results of three studies have suggested that the method adds prognostic value to isolated markers such as ankle-brachial index (ABI), diabetes, and high-sensitivity C-reactive protein (hsCRP).In conclusion, brachial artery FMV predicts cardiovascular risk, but its incremental predictive value to clinical prognostic models has not been established. In addition, solid evidence supporting its use in routine clinical practice to predict cardiovascular risk still lacks.

New Therapeutic Implications of Endothelial Nitric Oxide Synthase (eNOS) Function/Dysfunction in Cardiovascular Disease

“…Results of the general population-based Gutenberg Health Study (5000 individuals) revealed a strong correlation between the biomarker of cardiovascular disease, pro atrial natriuretic peptide (ANP), and non-invasive measurement of conduit artery and peripheral arterial performance [88]. A meta-analysis of 15 cohort studies reported a significant correlation of endothelial function measurements using FMD with diagnosed atherosclerosis in patients [89]. These reports are contrasted by the failure of endothelial function to predict cardiovascular events in mostly healthy subjects [90] and in individuals with intermediate cardiovascular risk [91].…”

Sex‐Specific Genetic Variants are Associated With Coronary Endothelial Dysfunction

“…Coronary endothelial dysfunction (CED) is an early stage in the development of atherosclerosis and is an independent predictor of adverse cardiovascular outcomes 1, 2, 3, 4, 5. Sex has been identified as an independent factor contributing to cardiovascular disease morbidity and mortality and endothelial dysfunction, but the role of CED has not been fully explored 2, 6…”

Use of Resveratrol in Cardiovascular Diseases Prevention: A Systematic Review

“…Moreover, it is important to point out that the technique use for measurement of endothelial function in the studies included, is based on the increase in blood flow, causing dilatation of the vessels locally 35 . In spite of being a mechanical and observer dependent method, it is reliable and accurate 36 .…”