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(Circulation. 2008;117:2428-2430.)
© 2008 American Heart Association, Inc.

Editorial

Reliable Endothelial Function Testing

At Our Fingertips?

David S. Celermajer, MB, BS, DSc

From the Department of Medicine, University of Sydney, and Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.

Correspondence to David S. Celermajer, MB, BS, DSc, Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Sydney, Camberdown NSW 2050, Australia.

Key Words: Editorials • atherosclerosis • endothelium • risk stratification • tests

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Noninvasive testing for the purpose of cardiovascular risk stratification has been a "holy grail" of Cardiology for some time. As the endothelium plays such a key role in normal vascular health and endothelial dysfunction is such an early event in atherogenesis, the appeal of endothelial function testing for risk stratification is easy to understand. Nevertheless, the goal of developing a noninvasive, widely applicable, reproducible, and informative test for endothelial function has so far proven elusive.

Article p 2467

	Why Endothelial Function Is Important

 
Although the healthy endothelium is only a monolayer of relatively simple cells that for many years was regarded as little more than a semipermeable barrier lining the vasculature, it is very well placed to exert many important homeostatic functions. The endothelium is exposed to a variety of blood-borne signals and intravascular stressors and has adapted to respond by secretion or modification of a large number of factors that regulate (inter alia) vascular tone, thromboresistance, and cellular adhesion. For example, the endothelium transduces the stimulus of increased shear stress into the response of vasorelaxation, facilitating one of the most basic cardiovascular homeostatic mechanisms of flow-mediated dilatation.

Furthermore, it transpires that some of the molecules secreted by a healthy endothelium have key functions in defense against atherosclerosis, including the important antiproliferative and antithrombotic molecules, nitric oxide (NO) and prostacyclin. In particular, the role of NO as an agent that not only vasodilates but inhibits platelet aggregation, monocyte adhesion to endothelial cells, and abnormal smooth muscle cell proliferation has highlighted the status of NO as . . . [Full Text of this Article]

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