Association between vascular endothelial dysfunction and stroke incidence in the general Japanese population: Results from the tohoku medical megabank community-based cohort study

Harutomo Numazaki; Takahito Nasu; Mamoru Satoh; Yuka Kotozaki; Kozo Tanno; Koichi Asahi; Hideki Ohmomo; Atsushi Shimizu; Shinichi Omama; Yoshihiro Morino; Kenji Sobue; Makoto Sasaki

doi:10.1016/j.ijcrp.2023.200216

Association between vascular endothelial dysfunction and stroke incidence in the general Japanese population: Results from the tohoku medical megabank community-based cohort study

Int J Cardiol Cardiovasc Risk Prev. 2023 Sep 21:19:200216. doi: 10.1016/j.ijcrp.2023.200216. eCollection 2023 Dec.

Authors

Harutomo Numazaki¹, Takahito Nasu^{1

2

3}, Mamoru Satoh³, Yuka Kotozaki^{3

4}, Kozo Tanno^{3

4}, Koichi Asahi^{3

5}, Hideki Ohmomo^{2

3}, Atsushi Shimizu^{2

3}, Shinichi Omama^{3

6}, Yoshihiro Morino², Kenji Sobue⁷, Makoto Sasaki^{3

8}

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Japan.
² Department of Biomedical Information Analysis, Institute for Biomedical Sciences, Iwate Medical University, Japan.
³ Iwate Tohoku Medical Megabank Organization, Iwate Medical University, Japan.
⁴ Department of Hygiene and Preventive Medicine, Iwate Medical University, Japan.
⁵ Division of Nephrology and Hypertension, Department of Internal Medicine, Iwate Medical University, Japan.
⁶ Division of General Medicine, Department of Critical Care, Disaster, And General Medicine, Iwate Medical University, Japan.
⁷ Department of Neuroscience, Institute for Biomedical Sciences, Iwate Medical University, Japan.
⁸ Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan.

Abstract

Background: Flow-mediated dilation (FMD) measures vascular endothelial function by evaluating the vasodilatory response of blood vessels to increased blood flow. Nevertheless, the association between FMD and stroke incidence in a general population remains unclear. This study investigated the association between vascular endothelial function and stroke incidence in the general Japanese population.

Methods: Based on cohort data from the Tohoku Medical Megabank Community-based Cohort Study, participants aged ≥18 years were recruited from Iwate Prefecture, with the final sample comprising 2952 subjects.

Results: The FMD level was 0.5%-27.1%, with a median of 5.0% (interquartile, 4.2%-11.3%). The mean follow-up period was 5.5 ± 1.8 years (range, 0.6-6.9 years). After dividing the participants into two subgroups according to the median FMD value, a multivariate Cox regression analysis adjusting for gender, age, smoking, alcohol consumption, systolic blood pressure, low-density lipoprotein cholesterol, estimated glomerular filtration rate, N-terminal pro-brain natriuretic peptide, high-sensitivity cardiac troponin T and hemoglobin A1c revealed that a lower FMD value was strongly associated with incidences of total stroke (hazard ratio[HR] = 2.13, 95% confidence interval[CI] = 1.48-3.07, p < 0.001), ischemic stroke (HR = 3.33, 95%CI = 2.00-5.52, p < 0.001), nonlacunar stroke (HR = 2.77, 95%CI = 1.49-5.16, p = 0.001), and lacunar stroke (HR = 5.12, 95%CI = 1.74-16.05, p = 0.003).

Conclusions: This study showed that a low FMD value might reflect vascular endothelial dysfunction and then was associated with ischemic stroke incidence in the general Japanese population, suggesting that FMD can be used as a tool to identify future stroke risk.

Keywords: Atherosclerosis; Cerebrovascular disease; Flow-mediated dilation; Follow-up study; Ischemic stroke.