Abstract

CHIRINO NAVARTA¹, Daniel Agustín et al. Evaluación de la disfunción endotelial en pacientes ambulatorios mayores de 75 años atendidos en un hospital de la tercera edad. Insuf. card. [online]. 2013, vol.8, n.3, pp.119-124. ISSN 1852-3862.

Endothelial dysfunction evaluation across ambulatory patients over 75 years of age treated at hospital for the elderly Objectives. Evaluate endothelial dysfunction through noninvasive techniques in elderly patients over 75 years of age, with no known history of cardiovascular disease, while controlling for some coronary risk factors. Material and methods. A Prospective study design, recruited seniors that received ambulatory care in the (Por Más Salud Dr. César Milstein) from July 2011 to January 2012. Inclusion criteria required patients to be aged = 75 years and have at least one of the following coronary risk factors (CRF): High blood pressure (hypertension), diabetes, dyslipidemia (DLP), smokers or ex-smokers and obesity. Exclusion criteria applied for those patients with cardiovascular history of previous infarction, stroke, peripheral vascular disease, heart failure, atrial fibrillation or flutter, and previous revascularization. We reviewed clinical charts, laboratory tests, and performed a physical examination. We evaluated endothelial dysfunction by measuring the vasoreactivity of the brachial artery after 5 minutes of tensiometer's insufflation and isosorbide dinitrate administration. Our outcome of interest included those subjects with dilation lower than 10% of the baseline diameter of the femoral artery. Multivariate logistic regression was used to analyze the behavior of all variables in a single model. Results. The final sample included 53 patients ranging from 80.4 ± 4.1 years, 29 women (55%). A history of hypertension was frequently reported (66%), followed by DLP (54%), ex-smokers (37%) and diabetes (17%). The outcome criteria was met by 23 patients (43.4%) with a percentage of brachial artery dilation of 6.1 ± 3% vs 21.9 ± 8%, compared to those without the criteria (p=0.0001). Both cases and controls were statistically similar in terms of age (81 ± 4.3 years vs 79 ± 3.9 years), intima-media thickness in both carotid arteries (0.9 ± 0.2 cm vs 0.8 ± 0,1 cm), HDL values (52 ± 8.2 mg/dL vs 50 ± 10 mg/dL), glucose (105 ± 19 mg/dL vs 102 ± 13 mg/dL) with a borderline-significant trend to higher LDL (131 ± 35 mg/dL vs 115 ± 23 mg/dL, p=0, 06). Regarding the CRF, both cases and controls were not significantly different in the history of hypertension (69% vs 63%), diabetes (16% vs 17%), DLP (60% vs 50%) and ex-smokers (30% vs 43%). Univariate analysis showed a positive, significant association between the outcome and history of obesity (30% vs 10%, p=0.05) and wider diameter of the brachial artery (4.3 ± 0.7 cm vs 3.9 ± 0.7 cm, p=0.04). However, those differences did not hold when the multivariate analysis was run. Conclusions. The endothelial dysfunction rate was associated with reactivity of the brachial artery in those older than 75 years of age. In addition, endothelial dysfunction was associated with a history of obesity and the increased diameter of the humeral cunning. There was a borderline-significant association between LDL increment and patients with endothelial dysfunction. However, multivariate analysis did not find any significant differences, suggesting none of the parameters explained endothelial dysfunction.

Keywords : Endothelial; Dysfunction; Brachial artery vasoreactivity; ; Elderly patients; ; Cardiovascular risk factors.

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