Rubinshtein et al. assessed the incremental value of the EndoPAT index to the Framingham Risk Score (FRS) in a cohort of 270 outpatients. Major Adverse Cardiovascular Events (MACE) that are cardiac death, myocardial infarction, revascularization or cardiac hospitalization, were recorded over an average follow-up period of 5.8 years. The rate of MACE in patients who tested positive for endothelial dysfunction was 39% vs. normal endothelial function 25% (p=0.024). The study showed that patients at low FRS risk but with Endothelial Dysfunction were at a higher actual risk of future CV events than patients with high FRS but normal Endothelial Function. Furthermore, Endothelial Dysfunction was found to be an independent risk factor for future MACE on multivariate analysis (p=0.002)