SYSTEMIC NATURE OF ENDOTHELIAL DYSFUNCTION IN ATHEROSCLEROSIS

Vascular endothelium plays a pivotal role In the maintenance of vasodi lation and the inhibition of platelet aggregation and smooth muscle ce ll proliferation through the release of nitric oxide and other factors . Extensive data have demonstrated abnormalities in coronary endotheli al function in the epicardial coronary arteries in patients with ather osclerosis or risk factors for atherosclerosis. This dysfunction leads to abnormal vasoconstriction and platelet aggregation, which likely p lay a role In producing ischemia In patients with coronary artery dise ase. invasive techniques have been available to assess endothelium-dep endent vasodilator responses in the coronary arteries. However, until recently little has been known about endothelial responses in the peri pheral vasculature, as methods to assess this have not been readily av ailable. The hypothesis that endothelial dysfunction is a systemic pro cess Is explored, and new noninvasive methods of assessing endothelial function are discussed.