Modulation of endothelial function: an objective to pursue in cardiovascular therapy

Abstract

Objective: The vascular endothelium has a central role in the functional and structural preservation of the vascular wall. Apart from vascular permeability, the endothelial cell significantly influences vascular tonus, haemostasis, cell proliferation, immunologic and inflammatory responses, and the phenotypic expression of smooth muscle cells. Intimately and pathophysiologically related to high blood pressure, dyslipoproteinaemia and atherosclerosis, the endothelial organ is nowadays viewed as the origin and the target for different types of therapy aiming to improve the prognosis of atherosclerotic disease, in general, and of coronary disease, in particular. The rationale, methodology and goals of some therapeutic strategies currently viewed as modulators of endothelial dysfunction are discussed. Methods: Clinical studies published since 1990 on endothelial dysfunction in atherosclerotic disease were selected from Medline. Their results were compared with basic structured information available from recent review articles and monographs. Conclusions: The acknowledged role of EDNO, prostacyclin, ET-1 and oestrogen in the development and progression of atherosclerotic disease, as well as in cardiovascular pathophysiology, makes it compulsory to bring forward therapies which will aim, as early on as possible, to correct endothelial dysfunction. Although this goal is not yet well grounded and acknowledged for all its implications, it is nevertheless pressing to recognise the relevance of this type of therapeutic intervention for the treatment of high blood pressure and dyslipoproteinaemia, as well as for the medical approach of the post-menopausal woman.