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Endothelial function as an end-point in interventional trials: concepts, methods and current data

T F Lüscher¹, G Noll

¹Cardiology, University Hospital, Zurich, Switzerland.

Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension

|September 1, 1996

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Assessing endothelial function in patients provides early detection of cardiovascular disease risk. This evaluation helps understand drug effects on vascular health, guiding future clinical outcome predictions.

Area of Science:

Cardiovascular Medicine
Vascular Biology

Background:

The endothelium plays a crucial role in cardiovascular function, mediating local responses and being susceptible to risk factors.
Endothelial dysfunction is an early indicator in cardiovascular disease development.
Key endothelium-derived factors include nitric oxide (vasodilator) and endothelin-1 (vasoconstrictor), influencing vascular tone and structure.

Purpose of the Study:

To review the assessment of endothelial function in vivo.
To discuss the impact of cardiovascular drugs on endothelial function.
To highlight the role of endothelial function as a potential surrogate endpoint in clinical trials.

Main Methods:

Endothelial function is evaluated in the coronary circulation using quantitative coronary angiography and Doppler flow wire.

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Peripheral circulation assessment employs plethysmography and ultrasound/Doppler devices.

Studies have utilized these methods to assess the effects of lipid-lowering drugs and angiotensin-converting enzyme (ACE) inhibitors.

Main Results:

Lipid-lowering drugs enhance endothelium-dependent vasodilation in hyperlipidemia and atherosclerosis.
Angiotensin-converting enzyme (ACE) inhibitors improve coronary vasomotion in coronary artery disease patients.
ACE inhibitors have not consistently improved vasodilation in hypertension, with further drug studies planned.

Conclusions:

Precise in vivo assessment of endothelial function is now feasible in both coronary and peripheral circulations.
Current tests can identify early endothelial dysfunction and predict drug efficacy.
Further large interventional trials are necessary to determine the predictive value of endothelial dysfunction for clinical outcomes.