A Comparison of Three Different Methods to Evaluate Endothelium-Dependent Vasodilation in the Elderly: The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) Study

• Published in: Arteriosclerosis, thrombosis, and vascular biology Vol. 25; no. 11; pp. 2368 - 2375
• Main Authors: Lind, Lars, Fors, Nilla, Hall, Jan, Marttala, Kerstin, Stenborg, Anna
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.11.2005; Hagerstown, MD Lippincott
• Subjects: Acetylcholine; Acetylcholine/diagnostic use; Aged; Atherosclerosis (general aspects, experimental research); Atherosclerosis - diagnostic imaging; Atherosclerosis - epidemiology; Atherosclerosis - physiopathology; Atherosclerosis/epidemiology/physiopathology/ultrasonography; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Brachial Artery - physiology; Cardiology. Vascular system; Cardiovascular system; Comparative Study; Dermatology; Diagnostic Techniques, Cardiovascular; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Endothelium, Vascular - physiology; Female; Forearm - blood supply; Humans; Male; Medical sciences; Pharmacology. Drug treatments; Prospective Studies; Pulsatile Flow; Risk Factors; Skin involvement in other diseases. Miscellaneous. General aspects; Sweden - epidemiology; Sympathomimetics; Sympathomimetics/diagnostic use; Terbutaline; Terbutaline/diagnostic use; Ultrasonography; Vasodilation; Vasodilator Agents; Vasodilator agents. Cerebral vasodilators; Vasodilator Agents/diagnostic use; Human; Vascular disease; Vasomotricity; Atherosclerosis; Risk factor; Cardiovascular disease; risk; cardiovascular; Elderly; Comparative study; Vasodilation; Endothelium; Diagnostic Techniques; Cardiovascular; Vascular/physiology
• ISSN: 1079-5642; 1524-4636; 1524-4636
• DOI: 10.1161/01.ATV.0000184769.22061.da

BACKGROUND—Three different techniques to evaluate endothelium-dependent vasodilation in the peripheral circulation have been described but not simultaneously tested in a large-scale population-based setting. This study aimed to evaluate the feasibility and usefulness of these techniques in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. METHODS AND RESULTS—In the population-based PIVUS study (1016 subjects aged 70 years), the invasive forearm technique with acetylcholine given in the brachial artery (EDV), the brachial artery ultrasound technique with measurement of flow-mediated dilatation (FMD), and the pulse wave analysis method with β-2-agonist (terbutaline) provocation were successfully used in 87%, 97%, and 86% of the sample, respectively. The results of EDV and pulse wave analysis were interrelated (r=0.12, P=0.0013), but no relationships were found with FMD measurements. All 3 techniques were correlated to the Framingham risk score (r=0.10 to 0.12, P=0.0007 to 0.001). In multiple regression analysis, however, only EDV and FMD were independently associated with the Framingham score. CONCLUSIONS—All 3 evaluated techniques were feasible to perform in a general elderly population. Both the invasive forearm technique and FMD were independently associated with increased coronary risk, suggesting that information on conduit artery and resistance artery endothelial function carry different, but important, information in the elderly. If the invasive technique cannot be used, the pulse wave based technique is an alternative.