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The hidden cause of coronary artery disease: How does poor endothelial function affect your health?
Coronary artery disease is a global health problem that affects the quality of life and lives of millions of people. Deep down in this problem, endothelial dysfunction plays an important and often overlooked role. This pathological condition primarily results from a decrease in the bioavailability of nitric oxide (NO), resulting in an inability of blood vessels to dilate normally, and in the process triggering a host of health problems.
The endothelium is a thin cell membrane that, in addition to being a barrier to blood vessels, is also responsible for maintaining vascular tone and regulating oxidative stress.
Endothelial function and coronary artery disease
Endothelial dysfunction is usually manifested as vasoconstriction, increased vascular permeability, thrombosis, and inflammatory response, and these changes are often exacerbated by increased levels of blood biomarkers such as C-reactive protein (CRP), albumin, and other biomarkers. These changes promote the development of vascular diseases such as atherosclerosis and may serve as predictors of more severe cardiovascular events.
The formation of atherosclerosis
Once endothelial function is damaged, monocytes and macrophages will be more likely to adhere to the blood vessel wall and promote the penetration of low-density lipoprotein (LDL). Oxidized LDL is one of the hallmarks of atherosclerosis. It promotes the formation of foam cells, further stimulates platelet activation, leads to instability of atherosclerotic plaques and causes rupture. Many studies have shown that improving hypertension or lowering LDL levels can significantly improve endothelial function, especially with the use of ACE inhibitors, calcium channel blockers, and statins.
Steady laminar flow and high shear stress can effectively protect blood vessels from the development of atherosclerosis, while disturbed flow can promote its formation.
The role of nitric oxide
Nitric oxide plays an important role in endothelial function. It not only inhibits platelet aggregation and inflammatory response, but also regulates the migration and proliferation of vascular smooth muscle cells. Endothelial dysfunction is characterized by an inadequate vascular response to stimuli such as exogenous nitroglycerin, resulting in the ineffective release of nitric oxide. This leads to increased vasoconstriction and other adverse effects.
Testing and diagnosis of endothelial function
In the coronary circulation, endothelial function can be assessed by angiography and ultrasonography. Noninvasive methods such as flow media dilation (FMD) are commonly used to measure endothelial function, but the results may be affected by a variety of physiological and technical factors.
Currently, FDA-approved devices for measuring endothelial function demonstrate 80% sensitivity and 86% specificity for effectively diagnosing coronary artery disease.
Correlation between endothelial function and stents
Studies have shown that stent implantation can reduce endothelial function. Although sirolimus-releasing stents are widely used because of their low restenosis rates, they have also been found to often impair endothelial function and worsen disease progression.
Health impacts of COVID-19The pulmonary complications of COVID-19 are in fact also related to endothelial dysfunction, which can cause acute lung injury, increase medical challenges and increase the medical burden on patients.
Risk Reduction and Lifestyle Changes
Controlling high blood pressure and high cholesterol can improve endothelial function, especially in patients taking statins and antihypertensive drugs. Lifestyle changes, such as smoking cessation, have also been shown to have a positive effect on endothelial function and reduce the risk of serious cardiovascular events.
Although endothelial dysfunction is a potential health hazard, can we improve our health and prolong our lives through effective lifestyle and medical means?
