Interrelationships Among Flow-Mediated Vasodilation, Nitroglycerine-Induced Vasodilation, Baseline Brachial Artery Diameter, Hyperemic Shear Stress, and Cardiovascular Risk Factors

J Am Heart Assoc. 2017 Dec 29;7(1):e006797. doi: 10.1161/JAHA.117.006797.


Background: Flow-mediated vasodilation (FMD) of the brachial artery has been used for the assessment of endothelial function. Considering the mechanism underlying the vasodilatory response of the brachial artery to reactive hyperemia, hyperemic shear stress (HSS), a stimulus for FMD; nitroglycerine-induced vasodilation (NID), an index of endothelium-independent vasodilation; and baseline brachial artery diameter (BAD) are also involved in vasodilatory response. The purpose of this study was to investigate the interrelationships among FMD, HSS, NID, baseline BAD, and cardiovascular risk factors.

Methods and results: We measured FMD, HSS, NID, and baseline BAD simultaneously in 1033 participants (633 men and 400 women; mean age: 58.6±17.0 years). Framingham risk score was negatively correlated with FMD, HSS, and NID and was positively correlated with baseline BAD. HSS and NID were positively correlated with FMD, and baseline BAD was negatively correlated with FMD. In participants with normal NID, FMD was correlated with HSS, NID, and baseline BAD, all of which were independent variables of FMD in multivariate analysis. In participants with impaired NID, FMD was correlated with NID and baseline BAD, both of which were independent variables of FMD in multivariate analysis, but there was no association between FMD and HSS.

Conclusions: NID and baseline BAD were independent variables of FMD regardless of the status of endothelium-independent vasodilation, whereas there was a significant association between FMD and HSS in participants with normal NID but not in those with impaired NID. The influence of HSS on FMD seems to be dependent on the status of endothelium-independent vasodilation.

Keywords: brachial artery reactivity; endothelial function; flow‐induced dilation; shear stress; smooth muscle cell.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Flow Velocity
  • Brachial Artery / physiology*
  • Brachial Artery / physiopathology
  • Cardiovascular Diseases
  • Endothelium, Vascular / physiology
  • Endothelium, Vascular / physiopathology
  • Female
  • Humans
  • Hyperemia / physiopathology*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Nitroglycerin / pharmacology*
  • Risk Factors
  • Stress, Mechanical*
  • Vasodilation / drug effects*
  • Vasodilator Agents / pharmacology*


  • Vasodilator Agents
  • Nitroglycerin