REVIEW ARTICLES   

International Angiology 2002 June;21(2):109-16

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English

Endothelial dysfunction in the pathogenesis of atherosclerosis

Poredos P.

Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia

A ­healthy endo­the­li­um plays a cen­tral role in car­di­o­vas­cu­lar con­trol. Therefore, endo­the­lial dys­func­tion (ED), which is char­ac­ter­ized by an imbal­ance ­between relax­ing and con­tract­ing fac­tors, pro­co­ag­u­lant and anti­co­ag­u­lant sub­stanc­es, and ­between pro-inflam­ma­to­ry and anti-inflam­ma­to­ry medi­a­tors, may play a par­tic­u­lar­ly sig­nif­i­cant role in the path­o­gen­e­sis of ath­ero­scler­o­sis. ED is close­ly relat­ed to dif­fer­ent risk fac­tors of ath­ero­scler­o­sis, to their inten­sity and their dura­tion. The involve­ment of risk fac­tors in ED is also sup­port­ed by ­results of inter­ven­tion stud­ies that ­showed regres­sion of ED with treat­ment of risk fac­tors. The com­mon denom­i­na­tor where­by dif­fer­ent risk fac­tors cause ED is most prob­ably ­increased oxi­da­tive ­stress and/or inflam­ma­tion. ED pro­motes ath­ero­scler­o­sis and prob­ably plays an impor­tant role in the devel­op­ment of throm­bot­ic com­pli­ca­tions in the late stag­es of the dis­ease. As ED is a key under­ly­ing fac­tor in the ath­e­ros­cle­rot­ic pro­cess, mark­ers of endo­the­lial abnor­mal­ities have been ­sought. Detection of ED is based on tests of endo­the­li­um-depen­dent vas­o­mo­tion (dila­tion capa­bil­ity of periph­er­al and cor­o­nary arter­ies) and on cir­cu­lat­ing mark­ers of endo­the­lial func­tion (endo­the­lin-1, von Willebrand fac­tor, tis­sue plas­mi­no­gen acti­va­tor, plas­mi­no­gen acti­va­tor inhib­i­tor, adhe­sion mole­cules). Using these tests it is pos­sible to fol­low the dose-­response of harm­ful ­effects or risk fac­tors, and the ­effects of pre­ven­tive pro­ce­dures on ves­sel wall func­tion.