Regulation of angiogenesis and angiogenic factors by cardiovascular medications

Coronary artery disease (CAD) is the most important cause of death in the industrialized world. After experimental myocardial infarction, numerous dilated vessels appear in the border zone between the infarct and noninfarct areas. Angiogenic therapy has been widely regarded as an attractive approach for both treating CAD and enhancing arterioprotective functions of the endothelium. In this report, we critically review the evidence supporting the regulation of angiogenesis and angiogenic factors by cardiovascular medications such as statins, cholesterol ester transfer protein inhibitor, angiotensin II type 1 receptor blocker, angiotensin-converting enzyme inhibitor and calcium channel blocker, etc. Furthermore, in patients with CAD, vascular growth (vasculogenesis), capillary network growth (angiogenesis) and collateral artery growth (arteriogenesis), may be important. Current evidence from clinical trials on these therapies suggests that the development of coronary collateral circulation is likely to be a viable therapeutic strategy for CAD, while adaptation to chronic coronary stenosis can proceed. Many studies have suggested that newly developed strategies which include the administration of angiogenic growth factors and the transplantation of bone marrow-derived angioblasts are beneficial for the ischemic heart. Our assessment of the evidence in this review leads us to conclude that the development of collateral circulation using conventional cardiovascular medications may also play a critical role and needs to be reconsidered in the treatment of patients with CAD.