Vascular dysfunction is associated with major adverse cardiovascular events in prediabetes: A cohort study

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Updated: Sep 19, 2025

Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
08:42

Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research

Published on: October 22, 2014

27.5K

Dariya Kozlova1, Colin Gimblet1, Linder Wendt2

  • 1Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America.

Plos One
|June 5, 2025
PubMed

Insights

Prediabetes increases cardiovascular risk. Impaired endothelial function, measured by brachial artery flow-mediated dilation, independently predicts major adverse cardiovascular events in individuals with prediabetes.

Area of Science:

  • Cardiology
  • Endocrinology
  • Vascular Biology

Background:

  • Prediabetes is a significant public health issue linked to increased risk of major adverse cardiovascular events (MACE).
  • Vascular dysfunction, exacerbated by hyperglycemia, is associated with MACE in high-risk groups.
  • The specific contribution of vascular dysfunction to MACE in prediabetes remains unclear.

Purpose of the Study:

  • To investigate the association between vascular dysfunction and the risk of MACE in adults with prediabetes.
  • To determine if endothelial function, aortic stiffness, or coronary artery calcification predict MACE in prediabetes.

Main Methods:

  • An observational study involving 5742 adults from the Framingham Offspring and Generation III cohorts.
  • Prediabetes diagnosed using American Diabetes Association (ADA) criteria.
  • Vascular function assessed via brachial artery flow-mediated dilation (BA-FMD), carotid-femoral pulse wave velocity (cfPWV) for aortic stiffness, and coronary artery calcium (CAC) scoring.

Main Results:

  • Individuals with prediabetes exhibited lower BA-FMD and higher cfPWV and CAC scores compared to controls.
  • After adjusting for traditional cardiovascular risk factors, reduced BA-FMD (HR 0.93; 95% CI [0.90,0.97]) and elevated CAC score >100 (HR 4.15; 95% CI [2.24,7.70]) were significantly associated with MACE.
  • Carotid-femoral pulse wave velocity (cfPWV) did not show a significant association with MACE in this cohort.

Conclusions:

  • Vascular dysfunction, specifically impaired endothelial function (BA-FMD), is an independent predictor of MACE in individuals with prediabetes.
  • Targeting vascular dysfunction through therapeutic interventions may be a viable strategy to mitigate cardiovascular disease (CVD) risk in the prediabetes population.
Abstract

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