Circulation. 2007;115:1285-1295
doi: 10.1161/CIRCULATIONAHA.106.652859
doi: 10.1161/CIRCULATIONAHA.106.652859
(Circulation. 2007;115:1285-1295.)
© 2007 American Heart Association, Inc.
Contemporary Reviews in Cardiovascular Medicine |
Endothelial Function and Dysfunction
Testing and Clinical Relevance
From the Vascular Physiology Unit (J.E.D., J.P.H.), UCL Institute of Child Health, London, UK; and the Department of Nephrology (T.R.), Leiden University Medical Center, Leiden, The Netherlands.
Correspondence to Dr. John E Deanfield, Professor of Cardiology, Vascular Physiology Unit, Institute of Child Health, and Great Ormond Street Hospital for Children NHS Trust, 30 Guilford St, London WC1N 3EH, UK. E-mail j.deanfield@ich.ucl.ac.uk
Key Words: atherosclerosis • endothelium • nitric oxide • risk factors • tests
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
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Introduction |
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Atherosclerosis begins in childhood, progresses silently through a long preclinical stage, and eventually manifests clinically, usually from middle age. Over the last 30 years, it has become clear that the initiation and progression of disease, and its later activation to increase the risk of morbid events, depends on profound dynamic changes in vascular biology.1 The endothelium has emerged as the key regulator of vascular homeostasis, in that it has not merely a barrier function but also acts as an active signal transducer for circulating influences that modify the vessel wall phenotype.2 Alteration in endothelial function precedes the development of morphological atherosclerotic changes and can also contribute to lesion development and later clinical complications.3
Appreciation of the central role of the endothelium throughout the atherosclerotic disease process has led to the development of a range of methods to test different aspects of its function, which include measures of both endothelial injury and repair. These have provided not only novel insights into pathophysiology, but also a clinical opportunity to detect early disease, quantify risk, judge response to interventions designed to prevent progression of early disease, and reduce later adverse events in patients.
The present review summarizes current understanding of endothelial biology in health and disease, the strengths and weaknesses of current testing strategies, and their potential applications in clinical research and patient care.
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Endothelium in Normal Vascular Homeostasis |
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Although only a simple monolayer, the healthy endothelium is optimally placed and is able to respond to physical and chemical signals by production of a wide range of factors
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