Investigation of endothelial function in populations at high cardiovascular risk

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Endothelial dysfunction is a disease process that occurs throughout the vascular system and results in abnormal regulation of blood vessel tone and the loss of atheroprotective properties of normal endothelium. The presence of endothelial dysfunction in coronary or peripheral arteries is an independent predictor of future cardiovascular events. While it is well known that vascular dysfunction is associated with type II diabetes, the effects of standard treatments for this disease such as statins and fibrates on vascular function is less clear. This is even more so for type II diabetes patients with acute coronary syndrome. The assessment of arterial endothelial function using strain gauge plethysmography is considered the “gold standard” of endothelial function testing. However, it is invasive and not applicable to large patient populations. Therefore, recent non-invasive techniques such as Endo-PAT have been developed to overcome these shortfalls. Endo-PAT is a non-invasive peripheral arterial tonometer (PAT) which measures the changes in pulse wave amplitude (PWA) in the fingertip of the index finger. While Endo-PAT is approved by the U.S Food and Drug Authority, its reliability in detecting endothelial dysfunction in different patient cohorts is still being established. Aims: Our study aims to answer two research questions: Do patients at high cardiovascular risk under standard clinical care exhibit endothelial dysfunction? We will examine endothelial function using both forearm venous occlusion plethysmography and Endo-PAT. The second research question is how reliable is the EndoPAT device in detecting endothelial dysfunction compared to strain gauge plethysmography?

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