Improving outcomes by targeting endothelial function

  • Persistent Impairment of Endothelial Vasomotor Function
    Has a Negative impact on Outcome in Patients with
    Coronary Artery disease. Kitta et al, JACC 2009

    • Method: 251 patients with newly diagnosed coronary artery disease and an impaired flow-mediated
      dilation (FMD) of the brachial artery (FMD5.5%).  After the first FMD measurement, all patients had
      individualized, optimized therapies including medications and life-style changes to reduce risk factors for
      CAD according to the AHA/ACC guidelines. Measurement of FMD was repeated after 6 months.
      After that, patients were followed up for 36 months or until 1 of the following events occurred:
      cardiac death, nonfatal  myocardial infarction, recurrent and refractory angina pectoris requiring coronary
      revascularization or ischemic stroke.
    • Results: FMD was persistently impaired (<5.5%) in 104 (41%) patients after 6 months of optimized
      therapy, whereas it  improved (FMD ≥5.5%) in the  remaining 147 (59%) patients. During 36 months
      of follow-up, events occurred in 27 (26%) patients  with persistently impaired FMD and in 15 (10%)
      patients with improved FMD (p0.01). Multivariate Cox hazards analysis showed that persistent
      impairment of FMD was an independent predictor of events (hazard ratio: 2.9, 95% confidence
      interval: 1.5 to 6.2, p0.01).
    • Conclusion: Persistent impairment of endothelial vasomotor function despite optimized therapy to
      reduce risk factors has an adverse impact on  outcome in coronary artery disease patients.