Endothelial dysfunction and coronary artery disease

Vascular endothelium is considered as an endocrine, paracrine and autocrine organ related to maintenance of vascular homeostasis. It is generally accepted that the onset of the atherosclerotic process begins with endothelial dysfunction. The endothelium controls the balanced release of various vasoconstrictive or vasodilating substances, regulates the coagulation and fibrinolysis systems, as well as secretes various pro- or anti-inflammatory mediators, proliferative and antiproliferative factors. A complete understanding of endothelial dysfunction includes a generalized defect in all homeostatic mechanisms related to endothelial function.

Playing an important role in atherosclerosis, endothelial dysfunction is also related to the various vascular localizations - coronary, peripheral, cerebral.
The subject of the monographic work is the disclosure of the complex interactions of endothelial dysfunction and coronary heart disease. Considering that ischemic heart disease has different forms, endothelial dysfunction is intertwined with them in different ways.
The monograph devotes a large section to the functions of the normal endothelium. From there, the complex concept and manifestations of endothelial dysfunction are formulated.

Braunwald's Heart Disease Review…

A special section is devoted to ways of studying endothelial dysfunction. By itself, it can affect both large arteries and microcirculation. Studies of endothelial dysfunction of large arteries have the advantage of establishing functional and structural changes in them. Changes in the microcirculation are difficult to visualize and primarily their functional deviations are determined.

From a clinical point of view, it is of particular importance to determine what is the cause of the ischemia - large epicardial vessels or microcirculation. It is simplistic to equate ischemia with coronary stenosis or spasm. In some cases, changes in the microcirculation can be leading - microvascular angina, Takotsubo cardiomyopathy, "X" syndrome, non-obstructive coronary accidents. The interplay between macro- and micro-vascular coronary endothelial dysfunction is common and complex. This interaction is almost mandatory in acute coronary syndromes, the processes of destabilization and occlusion of the coronary vessel, as well as in subsequent recanalization and invasive procedures.

Opie's Cardiovascular Drugs: A…

Endothelial dysfunction is not only the beginning of the atherosclerotic process, but also a concomitant phenomenon in the subsequent stages of atherosclerosis and its complications. It is relevant in the entire process of the cardiovascular continuum: from the initial vascular damage, through the formation of the atherosclerotic plaque, the occurring complications to the terminal stage. In the monographic work, there is an effort to determine its importance for the various clinical manifestations and complications of coronary disease.

Special attention is paid to the possibility of influencing endothelial dysfunction. The non-medicinal and medicinal means for its influence are examined in detail. Bearing in mind the importance of endothelial dysfunction for vascular aging and global health, the factors that cause it are formulated. Caring for the normal functioning of the endothelium goes through the prevention of risk factors, a healthy lifestyle (diet, physical activity), drug therapy.

• Endothelial dysfunction and
• coronary disease