Related Experiment Video
Updated: May 4, 2026
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Peripheral microvascular dysfunction predicts residual risk in coronary artery disease patients on statin therapy
Yuya Matsue1, Kazuki Yoshida2, Wataru Nagahori3
1Department of Cardiology, Kameda Medical Center, Chiba, Japan; Life Science and Bioethics Research Center, Tokyo Medical and Dental University, Tokyo, Japan.
Insights
Microvascular dysfunction (MiD), measured by peripheral artery tonometry (PAT), predicts coronary artery events (CAE) in patients with coronary artery disease (CAD) on statin therapy. This non-invasive measure improves risk prediction beyond traditional factors.
Area of Science:
- Cardiology
- Vascular Biology
- Predictive Diagnostics
Background:
- Statins are crucial for lowering LDL-C in coronary artery disease (CAD) patients.
- Residual risk of secondary coronary artery events (CAE) persists despite statin therapy.
- Microvascular dysfunction (MiD) is a potential contributor to this residual risk.
Purpose of the Study:
- To evaluate if microvascular dysfunction (MiD), assessed by peripheral artery tonometry (PAT), can predict prognosis in CAD patients treated with statins.
- To determine if PAT-derived measures add predictive value to established risk factors.
Main Methods:
- 213 CAD patients with LDL-C <100 mg/dL on statins underwent peripheral artery tonometry (PAT).
- Log-transformed reactive hyperemia index (L_RHI) was measured.
- Patients were followed for secondary CAE over a median of 2.7 years.
Main Results:
- CAE occurred in 15.8% of patients with L_RHI < 0.54 versus 4.0% with L_RHI ≥ 0.54 (P=0.006).
- L_RHI was an independent predictor of CAE after adjusting for traditional risk factors (FRF) and estimated glomerular filtration rate (eGFR).
- Adding L_RHI to FRF and eGFR significantly improved the predictive model's accuracy (AUC increased from 0.71 to 0.77).
Conclusions:
- Non-invasive measurement of microvascular dysfunction (MiD) using PAT provides incremental predictive value.
- MiD assessment can enhance risk stratification for secondary CAE in statin-treated CAD patients.
- This approach offers a promising tool for refining prognosis in cardiovascular care.
Objective:
Although lowering of low-density lipoprotein cholesterol (LDL-C) by statins is essential in treatment of coronary artery disease (CAD) patients, there is considerable residual risk of secondary coronary artery events (CAE). We examined whether microvascular dysfunction (MiD), measured by peripheral artery tonometry (PAT), can predict prognosis of CAD patients previously treated with statins.
Methods:
We measured log-transformed reactive hyperemia index (L_RHI) in 213 CAD patients who had already achieved LDL-C <100 by statin therapy. Patients were followed-up for secondary CAE for a median of 2.7 years. Patients were divided into two groups: L_RHI ≥ 0.54 (n = 99) and L_RHI < 0.54 (n = 114).
Results:
During follow-up, CAE occurred in 4 (4.0%) patients in the L_RHI ≥ 0.54 group and 18 (15.8%) patients in the L_RHI < 0.54 group (P = 0.006). Cox regression analysis indicated that L_RHI was an independent predictor for CAE even after adjustment by Framingham traditional risk factors (FRF; age, T-C/HDL-C ratio, systolic blood pressure, diabetes, current smoker, and gender) and estimated glomerular filtration rate (eGFR) for secondary CAE (HR 0.79, 95% CI: 0.66-0.95). ROC analysis for CAE prediction showed that the AUC for models including FRF only, FRF + eGFR, and FRF + eGFR + L_RHI were 0.60, 0.71, and 0.77, respectively. Moreover, adding eGFR to FRF only (0.63, P = 0.003) and adding L_RHI to the FRF + eGFR model were associated with significant improvement of net reclassification improvement (0.79, P = 0.007).
Conclusion:
MiD measured by non-invasive PAT adds incremental predictive ability to traditional risk factors for prognosis of CAD patients successfully treated with statins.
Related Concept Videos
01:30Peripheral Artery Disease I: Introduction
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:26Peripheral Artery Disease IV: Nursing Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology