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Ultrasound of the brachial artery is widely used to assess endothelial function, but whether brachial artery flow-mediated vasodilation(FMD) differs between women and men who have coronary artery disease(CAD) has not been examined. To investigate gender-based differences in brachial artery FMD as an indicator of significant CAD, FMD was measured in women and men outpatients who had CAD(coronary stenosis >50% , n=64) and those who did not have significant CAD(n=145). FMD in women who had CAD(n=33, 9.1± 0.8% ) was higher than that in similarly aged men who had CAD(n=31, 6.4± 0.5% ; p=0.008). The FMD cutpoint that maximized sensitivity with least effect on specificity for screening CAD was 15% (91% sensitivity, 25% specificity) in women but 10% (90% sensitivity, 43% specificity) in men. If the cutpoint as defined in men were used to evaluate women, brachial artery ultrasound would fail to diagnose 42% of women who do not have significant CAD; thus, a higher FMD cutpoint is required to optimize the sensitivity of FMD for identifying women who have significant CAD compared with similarly aged men. In studies using FMD to evaluate cardiovascular risk, different standards should be applied for women and men.
Ultrasound of the brachial artery is widely used to assess endothelial function, but whether either brachial artery flow-mediated vasodilation (FMD) differs between women and men who have coronary artery disease (CAD) has not been examined. To investigate gender-based differences in brachial artery FMD as an indicator of significant CAD, FMD was measured in women and men outpatients who had CAD (coronary stenosis> 50%, n = 64) and those who did not have significant CAD (n = 145). The FMD cutpoint that maximized sensitivity with least effect on specificity for screening (n = 33, 9.1 ± 0.8%) was higher than that in previously aged men who had CAD (n = 31, 6.4 ± 0.5%; p = 0.008) CAD was 15% (91% sensitivity, 25% specificity) in women but 10% (90% sensitivity, 43% specificity) in men. If the cutpoint as defined in men were used to evaluate women, brachial artery would would not to diagnose 42% of women who do not have significant CAD; thus, a higher FMD cutpoint is required to o ptimize the sensitivity of FMD for identifying women who have significant CAD compared with similarly aged men.