Background: The assessment of endothelial function has been accepted as an independent surrogate marker of cardiovascular disease (CVD), having both positive prognostic and diagnostic implications. The Digital Volume Pulse (DVP) analysis technique is a non–invasive approach to derive endothelial function. However, the utility and clinical application of this analysis technique has not been established.

Methods: we determined the discriminatory performance of the DVP analysis technique in identifying the people with established risk indices compared to a healthy population (West Midlands of the UK). Endothelial dependent and independent vessel function (Δ RI) was calculated by analyzing the change in digital pulse wave forms obtained by DVP photoplethysmography technique(Micro Medicals)

Results: Of our cohort of (n=225) (60.1% male; mean age 53.7 (SE 1.5) years), 155 had established CVD risk factors and had significantly (P<0.001) impaired endothelial function (Δ RI% (SE) [Diabetes : 4.6%(0.3), Hypertension: 6.9(0.6), hypercholesteremia 6.4(0.6)] compared to healthy controls [10.5(0.5)]. On univariate analysis, endothelial function was strongly associated with glycaemic status (R:−0.38, P= <0.001) In multivariate analysis, after adjusting for age and other risk factors, glycaemic status independently predicted endothelial function (Beta: −2.32(95% CI:−4.36—0.03), P=0.04) In ROC analysis Δ RI was a better discriminator (AUC(SE): 0.7(0.06) compared to individual CVD risk factors such as mean blood pressure, wait hip ratio and total serum cholesterol level.

Conclusion: Measurement of endothelial function by DVP analysis technique provides a non- invasive method of measuring endothelial function in clinical practice for the discrimination of people with established risk factors and may aid more precise cardiovascular risk stratification.