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Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
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Cardiovascular risk factors and endothelial dysfunction

Anthony S Wierzbicki1, Philip J Chowienczyk, John R Cockcroft

  • 1Department of Chemical Pathology, King's College London (King's, Guy's & St. Thomas' Medical School), St. Thomas' Hospital Campus, Lambeth Palace Road, London SE1 7EH, UK. Anthony.Wierzbicki@kcl.ac.uk

Clinical Science (London, England : 1979)
|September 29, 2004
PubMed

Insights

Endothelial dysfunction, a marker of atherosclerosis, correlates with cardiovascular risk factors. This study found endothelial dysfunction linked to the number of risk factors and specific lipids, highlighting its association with coronary heart disease (CHD).

Area of Science:

  • Cardiovascular Medicine
  • Atherosclerosis Research
  • Endothelial Function Studies

Background:

  • Endothelial dysfunction is a key indicator in atherosclerosis and correlates with coronary heart disease (CHD) risk factors.
  • Understanding the link between endothelial dysfunction and calculated cardiovascular risk is crucial for risk stratification.

Purpose of the Study:

  • To investigate the relationship between the degree of endothelial dysfunction and calculated cardiovascular risk using multiple risk algorithms.
  • To determine how individual risk factors contribute to endothelial dysfunction compared to their role in risk calculators.

Main Methods:

  • Assessed endothelial function via the acetylcholine/sodium nitroprusside (ACh/NP) response ratio using brachial plethysmography.
  • Compared endothelial function with cardiovascular risk calculated using Framingham, PROCAM, and MRFIT algorithms in 246 patients, including those with established CHD.

Main Results:

  • Endothelial dysfunction correlated with the total number of cardiovascular risk factors (r²=0.22; P=0.002) and was associated with low-density lipoprotein-cholesterol in men and triacylglycerols in women.
  • The ACh/NP ratio showed a strong correlation with diabetes, CHD presence (area=0.706+/-0.04; P=0.001), and LDL-cholesterol concentration (r²=0.58; P<0.001).
  • Correlation with calculated risk varied by algorithm; a stronger link was observed with the PROCAM algorithm (r²=0.41; P<0.005), reflecting contributions from male sex, LDL-cholesterol, and triacylglycerols.

Conclusions:

  • Endothelial dysfunction is significantly associated with established coronary heart disease and overall cardiovascular risk.
  • Individual risk factors contribute differently to endothelial dysfunction than captured by standard risk calculators, suggesting a need for refined risk assessment tools.
  • The PROCAM algorithm demonstrated a stronger association with endothelial dysfunction compared to Framingham and MRFIT, likely due to its inclusion of specific lipid parameters and sex.

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