The prevalence of endothelial dysfunction in patients with and without coronary artery disease

Clin Cardiol. 2010 Dec;33(12):746-52. doi: 10.1002/clc.20836.


Background: Endothelial dysfunction (ED) is frequently present in patients presenting with acute or stable coronary artery disease (CAD), but it is also found in patients presenting with chest pain without angiographic coronary lesions.

Hypothesis: We hypothesized that even in patients without CAD, the presence of cardiovascular (CV) risk factors will correlate with the presence of ED.

Methods: Our study included a total of 341 consecutive patients referred for coronary angiography. We used pulse wave analysis with a finger plethysmograph (peripheral arterial tonometry) to determine endothelial function. Hyperemia ratio was calculated as the ratio of the postischemic hyperemia response relative to baseline measurement.

Results: The hyperemia ratio was significantly higher in patients without CAD (2.02 ± 0.52) compared with patients with chronic CAD (1.81 ± 0.44, P = 0.001) or acute CAD (1.74 ± 0.49, P < 0.001). Prevalence of ED was 33%, 46%, and 58%, respectively. In multivariate analysis, the presence of CAD, diabetes, and cigarette smoking, and the total number of CV risk factors, were strong predictors of ED. In 67% of the patients without CAD but with ≥3 CV risk factors, ED was present.

Conclusions: Prevalence of ED in patients with chest pain depends on the presence of CAD and CV risk factors. Patients without CAD but with ≥3 risk factors frequently presented with ED. Such patients may be at increased risk for future CV events and may profit from intensified therapy to control CV risk factors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Angina Pectoris / diagnosis
  • Angina Pectoris / epidemiology
  • Angina Pectoris / physiopathology*
  • Chi-Square Distribution
  • Coronary Angiography
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / physiopathology*
  • Endothelium, Vascular / physiopathology*
  • Female
  • Fingers / blood supply*
  • Hemodynamics*
  • Humans
  • Hyperemia / physiopathology
  • Logistic Models
  • Male
  • Manometry
  • Middle Aged
  • Odds Ratio
  • Plethysmography
  • Predictive Value of Tests
  • Prevalence
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Switzerland