Time-Course Analysis of Flow Mediated Dilation for the Evaluation of Endothelial Function After a High-Fat Meal in African Americans

Alejandro Marinos, Jorge E Celedonio, Claudia E Ramirez, JoAnn Gottlieb, Alfredo Gamboa, Nian Hui, Chang Yu, C Michael Stein, Italo Biaggioni, Cyndya A Shibao, Alejandro Marinos, Jorge E Celedonio, Claudia E Ramirez, JoAnn Gottlieb, Alfredo Gamboa, Nian Hui, Chang Yu, C Michael Stein, Italo Biaggioni, Cyndya A Shibao

Abstract

Background: Flow-mediated dilation (FMD) is used to assess endothelial function through changes in vascular diameter after hyperemia. High-fat meal (HFM) has been shown to induce endothelial dysfunction; recent studies, however, reported conflicting results in obese African American women (AAW). Differences in the method used to analyze FMD may explain these discrepancies.

Methods and results: In protocol 1, we assessed the time course of FMD and compared the repeatability of FMD using the individual maximum peak dilation (FMDpeak) and the dilation at 60 seconds (FMD60). Sixteen AAW (age, 42±10.4 years; body mass index [BMI], 39±5.8 kg/m(2)) were studied on 2 occasions, 4 weeks apart, under fasting conditions (study 1 and study 2). In protocol 2, we used the most repeatable measurement from protocol 1 to assess changes in endothelial function after an HFM in 17 AAW (agen 42±11.1 years; BMIn 38±5.6 kg/m(2)). We found that FMDpeak was the most repeatable measurement (N=16; study 1, 5.31±3.12% and study 2, 5.80±2.91%; r=0.94). After an HFM, the baseline brachial artery diameter significantly increased at 2 hours (0.10 mm; 95% confidence interval [CI], 0.01-0.18; P=0.03) and at 4 hours (0.17 mm; 95% CI, 0.09-0.25; P<0.001). At 2 hours, the FMDpeak decreased compared with pre-HFM (-1.76; 95% CI, -3.55-0.02; P≤0.05).

Conclusions: The individual's maximum peak dilation after hyperemia is the most consistent measure to assess the effect of an HFM on endothelial function. Endothelial dysfunction occurred at 2 hours after an HFM in AAW.

Clinical trial registration: URL: https://ichgcp.net/clinical-trials-registry/NCT01334554" title="See in ClinicalTrials.gov">NCT01334554 and NCT02126735.

Keywords: African American; endothelial dysfunction; high fat diet; obesity.

© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Figures

Figure 1
Figure 1
A, Ultrasound image of the brachial artery. The box is the region of interest used by the continuous edge detection and wall tracking software to determine brachial artery diameter and flow measurements. B, Vessel diameter vs frames curve (raw data) generated by the automatic edge detector software. C, The method we used to smooth the curve for peak detection. We calculated the median of a specific number of consecutive samples and then shifts to the next data bracket that overlap with the samples just analyzed. For all of our analysis, we used a data bracket of 50 samples with a 20% overlap. D, Final graphic (vessel diameter vs time) after our method is applied. Our custom design software calculated automatically the time to peak and peak dilation. ROI indicates region of interest.
Figure 2
Figure 2
Left panel (A) showed the correlation between 2 measurements using flow‐mediated dilation (FMD)peak, separated by 4 weeks (study 1 and study 2); right panel (A) showed the respective Bland‐Altman plot. Left panel (B) showed the correlation between study 1 and study 2 with FMD 60; right panel (B) showed the respective Bland‐Altman plot. Left panel (C) showed the correlation between study 1 and study 2 with time to peak; right panel (C) showed the respective Bland‐Altman plot.
Figure 3
Figure 3
A, Baseline brachial artery diameter and maximum peak diameter postcuff deflation pre‐HFM and at 2 and 4 hours post‐HFM. B, Baseline brachial artery diameter and 60 seconds diameter postcuff deflation pre‐HFM and 2 and 4 hours post‐HFM. C, Changes in FMD peak post‐HFM. D, Changes in FMD 60 after HFM. *P<0.05; **P<0.001. FMD indicates flow‐mediated dilation; HFM, high‐fat meal; NS, not significant.
Figure 4
Figure 4
Changes in glucose (A), insulin (B), free fatty acids (C), and isoprostane (D) levels before and 2 and 4 hours after high‐fat meal (HFM).
Figure 5
Figure 5
Power curves for future studies in order to detect indicated differences in the effect of HFM on FMD peak between African American and Caucasians, using 2‐sample t test with type I error rate of 0.05 and SD of 3.1. FMD indicates flow‐mediated dilation; HFM, high‐fat meal.

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