Integrated flow-mediated vasodilation response predicts cardiovascular events in elderly patients with cardiovascular risk factors: the Japan Morning Surge-Home Blood Pressure study

The integrated flow-mediated vasodilation (FMD) response has been associated with cardiovascular (CV) risk factors, but the association between the integrated FMD response and subsequent CV events has been unclear. We enrolled 555 patients who had at least one CV risk factor (hypertension, dyslipidemia, diabetes, or smoking). We measured the peak percentage change in diameter (Delta FMD), and integrated FMD response calculated as the area under the dilation curve over a 120-second dilation period (FMD-AUC(120)). Elderly patients (age >= 65 years, N = 270) in the lowest tertile of FMD-AUC(120) (FMD-AUC(120) < 5.6) had a higher rate of CV events compared with those in the two higher tertiles (FMD-AUC(120) >= 5.6) (log rank 4.15, P = .041). The association remained significant after adjusting for covariates (hazard ratio 3.84, P = .007). In the 285 middle-aged patients (age < 65 years), the CV event rates were similar between patients in the lowest tertile and those in the two higher tertiles of FMD-AUC(120) (log rank 0.39, P = .53). The CV event rates were similar between patients in the lowest tertile and those in the two higher tertiles of Delta FMD in elderly and middle-aged patient groups. In conclusion, integrated flow-mediated vasodilation response, but not Delta FMD, predicted CV events in elderly patients with CV risk factors. (C) 2018 American Heart Association. All rights reserved.