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Usefulness of carotid intimal medial thickness and Flow-Mediated dilation in a preventive cardiovascular practice

      In 1995, the University of Virginia started measuring common/mean carotid intimal medial thickness (IMT) and post–ischemia-induced flow-mediated dilation (FMD) as measures of subclinical arteriosclerosis. These tests were performed in patients with intermediate cardiovascular risk based on standard risk factors. IMT is a direct measure of carotid arteriosclerosis and an indirect measure of generalized atherosclerosis.
      • Simon A.
      • Gariepy J.
      • Chironi G.
      • Megnien J.L.
      • Levenson J.
      Intima-media thickness a new tool for diagnosis and treatment of cardiovascular risk.
      O’Leary et al
      • O’Leary D.H.
      • Polak J.F.
      • Kronmal R.A.
      • Manolio T.A.
      • Burke G.L.
      • Wolfson S.K.J.
      Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group.
      found that increased common carotid IMT predicted myocardial infarctions in elderly patients. FMD is a measure of nitric oxide release from the forearm arterial endothelium.
      • Bassenge E.
      • Busse R.
      Endothelial modulation of coronary tone.
      ,
      • Corretti M.C.
      • Anderson T.J.
      • Benjamin E.J.
      • Celermajer D.
      • Charbonneau F.
      • Creager M.A.
      • Deanfield J.
      • Drexler H.
      • Gerhard-Herman M.
      • Herrington D.
      • et al.
      Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery a report of the International Brachial Artery Reactivity Task Force.
      In patients with a healthy endothelium, forearm ischemia induces greater nitric oxide release, and therefore, greater brachial artery dilation. Endothelial dysfunction is one the first abnormalities found in arteriosclerosis,
      • Celermajer D.
      • Sorensen K.E.
      • Gooch V.
      • Speigelhalter D.
      • Miller O.
      • Sullivan I.
      • Lloyd J.
      • Deanfield J.
      Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis.
      dyslipidemia,
      • Chowienczyk P.
      • Watts G.
      • Cockroft J.
      • Ritter J.
      Impaired endothelium dependent vasodilation of forearm resistance vessels in hypercholesterolemia.
      and type 2 diabetes.
      • Williams S.B.
      • Cusco J.A.
      • Roddy M.
      • Johnstone M.T.
      • Creager M.A.
      Impaired nitric oxide-mediated vasodilation in patients with non-insulin-dependent diabetes melitus.
      ,
      • Caballero A.E.
      • Arora S.
      • Saouaf R.
      • Lim S.C.
      • Smakowski P.
      • Park J.Y.
      • King G.L.
      • LoGerfo F.W.
      • Horton E.S.
      • Veves A.
      Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 diabetes.
      Since 1995, 968 patients had FMD and IMT measured at the University of Virginia. It is known that age is a predictor of IMT
      • Homma S.
      • Hirose N.
      • Ishida H.
      • Ishii T.
      • Araki G.
      Carotid plaque and intima-media thickness assessed by b-mode ultrasonography in subjects ranging from young adults to centenarians.
      ; FMD is less well characterized. Celermajer et al
      • Celermajer D.
      • Sorensen K.E.
      • Gooch V.
      • Speigelhalter D.
      • Miller O.
      • Sullivan I.
      • Lloyd J.
      • Deanfield J.
      Noninvasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis.
      studied brachial and superficial femoral artery dilation and found an inverse relation between arterial diameter and percent artery dilation. We sought to more carefully characterize brachial artery FMD in addition to IMT. Therefore, we evaluated our cohort of patients to determine how to best interpret FMD and IMT results based on patient characteristics.
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