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Endothelial dysfunction: implications for therapy of cardiovascular diseases
D M Bell1, T E Johns, L M Lopez
1Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown 26506, USA.
The Annals of Pharmacotherapy
|April 30, 1998
Summary
Endothelial dysfunction, a key factor in cardiovascular diseases, is an early sign of atherosclerosis. While some treatments improve endothelial function, consistent restoration remains a challenge.
Area of Science:
- Cardiovascular Research
- Vascular Biology
- Medical Science
Background:
- Endothelial dysfunction is an early event in atherogenesis, characterized by impaired endothelium-dependent vascular relaxation.
- Peripheral endothelial dysfunction can indicate coronary artery impairment, serving as a crucial marker for cardiovascular disease.
- Current diagnostic techniques for endothelial dysfunction offer high specificity and positive predictive value for coronary artery disease but have limited sensitivity.
Purpose of the Study:
- To review the existing literature on endothelial dysfunction in cardiovascular diseases.
- To examine the implications of endothelial dysfunction for treating various cardiovascular disorders.
- To assess the effectiveness of different therapeutic agents in restoring endothelial function.
Main Methods:
- A comprehensive MEDLINE search was conducted for basic science articles on the endothelium's role in atherosclerosis.
- Clinical trials investigating the presence and treatment of impaired endothelium-dependent vascular relaxation were systematically reviewed.
- Selected articles and reviews were included to establish the foundational science for clinical trial analysis.
Main Results:
- Endothelial dysfunction is an early indicator of atherosclerosis and a marker for coronary artery impairment.
- Lipid-lowering agents and estrogen supplementation consistently improve endothelial function.
- Treatments for heart failure and hypertension have not consistently improved endothelial function.
Conclusions:
- Endothelial dysfunction is a significant marker for cardiovascular disease, though pharmacologic interventions do not reliably restore normal function.
- Despite inconsistent functional improvements, some agents used to treat endothelial dysfunction demonstrate positive clinical outcomes.
- Further research is needed to elucidate the impact of common cardiovascular therapies on the pathobiology of endothelial dysfunction.