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Open Access Highly Accessed Research article

Association between lowered endothelial function measured by peripheral arterial tonometry and cardio-metabolic risk factors – a cross-sectional study of Finnish municipal workers at risk of diabetes and cardiovascular disease

Jussi Konttinen1*, Harri Lindholm1, Juha Sinisalo2, Eeva Kuosma1, Janne Halonen1, Leila Hopsu1 and Jukka Uitti3

Author Affiliations

1 Finnish Institute of Occupational Health, Topeliuksenkatu 41 a, A, FI-00250 Helsinki, Finland

2 Helsinki University Central Hospital, Helsinki, Finland

3 Finnish Institute of Occupational Health, Uimalankatu 10, FI-33101 Tampere, Finland

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BMC Cardiovascular Disorders 2013, 13:83  doi:10.1186/1471-2261-13-83

Published: 11 October 2013



The aim of this cross-sectional study was to determine the association between lowered endothelial function measured by peripheral arterial tonometry (PAT) and cardio-metabolic risk factors. The study population consisted of Finnish municipal workers who were at risk of diabetes or cardiovascular disease and who had expressed a need to change their health behaviour.


A total of 312 middle-aged municipal workers underwent a physical medical examination and anthropometry measurements. Levels of total cholesterol, HDL cholesterol, triglycerides, fasting glucose, glycated haemoglobin, and high sensitivity C-reactive protein were taken from the blood samples. PAT measured the increase in digital pulse volume amplitude during reactive hyperemia, and the index of endothelial function, F-RHI, was defined as the ratio of post-deflation amplitude to baseline amplitude.


In the linear regression model, male sex was associated with lower F-RHI. In sex-adjusted linear regression models, each of the variables; waist circumference, fasting glucose, glycated hemoglobin, triglycerides, body fat percentage, body mass index, current smoking, and impaired fasting glucose or diabetes were separately associated with lower F-RHI, and HDL cholesterol and resting heart rate were associated with higher F-RHI.

HDL cholesterol, sex, body mass index, and current smoking entered a stepwise multivariable regression model, in which HDL cholesterol was associated with higher F-RHI, and smoking, male sex and body mass index were associated with lower F-RHI. This model explains 28.3% of the variability in F-RHI.


F-RHI is associated with several cardio-metabolic risk factors; low level of HDL cholesterol, male sex, overweight and smoking being the most important predictors of a lowered endothelial function. A large part of variation in F-RHI remains accounted for by unknown factors.

Cardiovascular risk; Endothelial dysfunction; Peripheral arterial tonometry; Occupational health care