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STATE-OF-ART PAPER

The clinical implications of endothelial dysfunction

^* Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, Massachusetts, USA

Manuscript received February 18, 2003; revised manuscript received April 27, 2003, accepted June 5, 2003.

^* Reprint requests and correspondence: Dr. Joseph A. Vita, Section of Cardiology, Boston Medical Center, 88 East Newton Street, Boston, Massachusetts 02118, USA.
jvita{at}bu.edu

Defining new approaches for the prevention and treatment of atherosclerosis is an important priority. Recently, measurement of endothelial function in patients has emerged as a useful tool for atherosclerosis research. Risk factors are associated with impaired endothelial function, and clinical syndromes relate, in part, to a loss of endothelial control of vascular homeostasis. Recent studies have shown that the severity of endothelial dysfunction relates to cardiovascular risk. A growing number of interventions known to reduce cardiovascular risk have been shown to improve endothelial function. This work suggests that studies of endothelial function could be used in the care of patients and as a surrogate marker for the evaluation of new therapeutic strategies. This article will review this growing literature in an effort to evaluate the current clinical utility of endothelial dysfunction.

Abbreviations and Acronyms   BP = blood pressure   CAD = coronary artery disease   CVD = cardiovascular disease   FMD = flow-mediated dilation   HRT = hormone replacement therapy   ICAM = intercellular adhesion molecule   NO = nitric oxide   VCAM-1 = vascular cell adhesion molecule-1

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