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Updated: Aug 7, 2026
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
The association between endothelial dysfunction and cardiovascular outcomes in a population-based multi-ethnic cohort
Daichi Shimbo1, Cairistine Grahame-Clarke, Yumiko Miyake
1Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY, United States.
Insights
Flow-mediated dilation (FMD) predicts cardiovascular events in the general population, but this association is not independent of traditional risk factors. Lower FMD indicates higher cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Preventive Cardiology
Background:
- Brachial artery flow-mediated dilation (FMD) is a marker of endothelial function.
- Its predictive value for cardiovascular events in lower-risk populations is not well-established.
Purpose of the Study:
- To investigate whether FMD predicts cardiovascular events in asymptomatic, general population individuals.
- To assess the independence of FMD's predictive value from established cardiovascular risk factors.
Main Methods:
- Prospective, multi-ethnic cohort study (Northern Manhattan Study) of 842 community participants.
- High-resolution ultrasonography used to measure brachial artery FMD.
- Follow-up for cardiovascular events (myocardial infarction, stroke, vascular death) at 36 months.
Main Results:
- Lower FMD levels predicted cardiovascular events over 36 months (HR=1.12 per 1% decrease, p=0.03).
- Individuals in the lowest two FMD tertiles (<7.5%) had significantly higher event risk compared to the highest tertile.
- This association lost statistical significance in multivariate analysis including cardiovascular risk factors.
Conclusions:
- Non-invasive FMD testing can predict incident cardiovascular events in a multi-ethnic, population-based sample.
- The predictive value of FMD is not independent of traditional cardiovascular risk factors.
Background:
Brachial artery flow-mediated dilation (FMD) may predict cardiovascular events in selected high-risk patients. Whether FMD testing predicts cardiovascular events in asymptomatic, lower risk individuals from the general population is unknown.
Methods And Results:
As a part of a multi-ethnic, prospective cohort study, the Northern Manhattan Study, we examined FMD by high-resolution ultrasonography in 842 community participants who were free of stroke or myocardial infarction. Lower FMD levels predicted cardiovascular events (myocardial infarction, stroke and vascular death) at 36 months of follow-up (hazard ratio (HR)=1.12 for every 1% decrease in FMD, 95% CI 1.01-1.25, p=0.03). The risk of events in patients with FMD in the lower two tertiles (FMD<7.5%) was significantly higher than those in the highest tertile (HR=3.28, 95% CI 1.07-10.06, p=0.04 for lowest versus highest tertile, and HR=3.05, 95% CI 1.03-9.66, p=0.04 for middle versus highest tertile). In a multivariate analysis including cardiovascular risk factors, the increase in risk associated with FMD was no longer statistically significant.
Conclusions:
Non-invasive FMD testing predicts incident cardiovascular events in this multi-ethnic, population-based sample, but its predictive value is not independent of cardiovascular risk factors.
