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From blood vessels to the heart: How to identify potential warning signs of endothelial dysfunction?
Poor endothelial function is a common hallmark of vascular disease. Many medical studies have clearly pointed out that poor endothelial function directly affects net blood flow and cardiovascular health, and may be related to the development of a variety of diseases. Endothelial cells are not only the first line of defense for blood vessels, responsible for maintaining the firmness and elasticity of blood vessels, but also play an important role in regulating oxidative stress.
Endothelial dysfunction is primarily due to reduced bioavailability of nitric oxide.
The manifestations of this dysfunction usually include vasoconstriction, increased vascular permeability, thrombosis and inflammatory response. The above pathological conditions are often accompanied by the increase of some biomarkers, such as prothrombin time, D-dimer, von Willebrand factor, fibrinogen, degradation products, C-reactive protein (CRP), ferritin, interleukin 6 (IL-6) and plasma creatinine.
Together, these changes contribute to the progression of vascular disease, leading experts to intensively investigate its potential prevention and treatment.
Association with atherosclerosis
Studies have shown that endothelial dysfunction plays an important role in the development of atherosclerosis and may even occur before vascular lesions occur. When endothelial function is poor, monocytes and macrophages are more likely to attach to the vascular lining and promote the penetration of low-density lipoprotein (LDL) in the vascular wall.
Oxidized low-density lipoprotein is an important feature of atherosclerosis, promoting the formation of foam cells, chemotaxis of monocytes and activation of platelets.
These processes ultimately lead to destabilization of arterial plaque, increasing the risk of blood vessel rupture. Hypertension and dyslipidemia are factors that lead to endothelial dysfunction, and the necessity of effective intervention measures to control blood pressure and lower LDL is becoming increasingly apparent.
The role of nitric oxide
Nitric oxide (NO) is essential in maintaining vascular health, and its functions include inhibiting platelet aggregation, anti-inflammation, and reducing oxidative stress. A hallmark of endothelial dysfunction is the inability of arteries to fully dilate in response to appropriate stimuli, a condition that is often associated with reduced NO bioavailability.
In clinical trials, tetrahydrobiopeptide (BH4) supplementation has been shown to improve endothelial function, but the issue of BH4 oxidation to BH2 remains.
Further studies have found that the use of different drugs such as ACE inhibitors and calcium channel blockers can effectively improve endothelial function and reduce the risk of cardiovascular disease.
Testing and diagnostic methods
There are many methods to examine endothelial function, among which coronary artery angiography, venous occlusion plethysmography and ultrasound examination of peripheral blood vessels are widely used. Among them, % Flow-Mediated Dilation (FMD) is particularly popular as a non-invasive method to measure endothelial function.
Tests for endothelial function, such as the von Wilbrand factor assay, also indicate the status of endothelial function. For example, the use of medical devices such as Itamar Medical's EndoPAT is also a non-invasive way to detect endothelial function, which can reflect the physiological condition of the coronary arteries.
Association between endothelial dysfunction and stents
Stent implantation is often associated with impaired endothelial function. Microsphere drug-eluting stents show a low rate of in-stent restenosis, but at the same time cause deterioration of endothelial function. This situation has prompted the medical community to re-explore the use of different drugs in order to improve the effect of endothelial recovery.
Complications of COVID-19
Endothelial dysfunction is also an important issue in COVID-19; the occurrence of acute lung injury can be directly related to endothelial dysfunction.
Risk Reduction Strategies
Experts generally agree that treatment of high blood pressure and high cholesterol can help improve endothelial function; positive effects can be seen with statins (HMG-CoA reductase inhibitors), ACE inhibitors, and calcium channel blockers . In addition, lifestyle changes, such as quitting smoking, can also help improve endothelial function and further reduce the risk of cardiovascular events.
After realizing the health problems caused by poor endothelial function, have you started to pay attention to your cardiovascular health?
