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Association of Transient Endothelial Dysfunction Induced by Mental Stress With Cardiovascular Events

in Patients With Coronary Artery Disease

Diabetes Metab Res Rev. 2019 Sep 11

Endothelial dysfunction and cardiovascular outcome in asymptomatic patients with type 2 diabetes mellitus: a pilot study.

Villano A1, Mencarelli E1, Melita V1, Rizzi A1, Lamendola P1, De Vita A1, Manfredonia L1, Ravenna SE1, Pitocco D1, Lanza GA1, Crea F1.

Author information


Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.



Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular events, but risk stratification of asymptomatic T2DM patients remains a challenging issue. We conducted a pilot study to assess whether endothelial dysfunction might help identify, among asymptomatic T2DM patients, those at increased risk of cardiovascular events.


We studied 61 consecutive T2DM patients with no evidence of cardiovascular disease and no insulin therapy. Endothelial function was assessed by flow-mediated dilation (FMD) of the right brachial artery. The primary endpoint was a combination of major cardiovascular events (MACE: cardiovascular death, acute coronary events, coronary interventions and acute cerebrovascular accidents). FMD was repeated at follow-up in 48 patients (79%).


A total of 10 MACE (16.4%) occurred during a mean follow-up of 48 months, including 3 acute myocardial infarctions, 5 coronary revascularisations for stable angina and 2 acute ischemic strokes. FMD at enrolment was lower in patients with compared to patients without MACE (3.78±0.97 vs. 4.70±1.33 %, respectively; p=0.04). No other clinical or laboratory variables (age, diabetes duration, glycated hemoglobin, cardiovascular risk factors, drug therapy, nitrate mediated dilation) were associated with MACE. FMD at follow-up was also lower in patients with (n=10) compared to those without (n=38) MACE (3.66±1.29 vs. 4.85±1.92; p=0.006).


Our data suggest that assessment of FMD might be helpful to identify patients at increased risk of MACE among individuals with asymptomatic T2DM; accordingly, a large study is warrented to adequately define the clinical utility of FMD assessment in the management of T2DM patients.

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