IMPACT OF NEUROENDOCRINE ACTIVATION ON CORONARY-ARTERY DISEASE

Several independent predictors of the risk of atherosclerosis are know n including plasma cholesterol concentration, cigarette smoking, eleva ted blood pressure, as well as genetic factors such as non-insulin-dep endent diabetes and plasma fibrinogen. Also known are the 3 major elem ents of the pathogenesis of atherosclerosis, involving modification of endothelial function, changes in vascular tone, and clinical sequelae of hyperplasia of smooth muscle cells in the intima of the affected b lood vessels. This article further examines vasoconstrictor/ vasodilat or balance, the role of angiotensin II, and the significant role playe d by the endothelium in the complex events and interactions that occur both with smooth muscle cells and platelets. Clinical evidence of end othelial dysfunction in coronary artery disease is presented. The impo rtance of the association of the progression of coronary artery diseas e with signs of neuroendocrine activation, the relation of endothelin- l to mechanisms of neuroendocrine activation, and how the counteractio n of this activation may have beneficial effects on disease progressio n are discussed. (C) 1998 by Excerpta Medica, Inc.