Dietary modulation of endothelial function: implications for cardiovascular disease

The vascular endothelium is the primary site of dysfunction in many disease s, particularly cardiovascular disease. A variety of risk factors, includin g smoking, hypercholesterolemia, hyperhomocysteinemia, hypertension, and di abetes mellitus, adversely affect endothelial function. Emerging evidence s uggests an important role of dietary factors in modulating endothelial func tion. In particular, n-3 fatty acids, antioxidant vitamins (especially vita mins E and C), folic acid, and L-arginine appear to have beneficial effects on vascular endothelial function, either by decreasing endothelial activat ion or by improving endothelium-dependent vasodilation in patients at high risk of cardiovascular disease as well as in healthy subjects. These effect s may serve as one potential mechanism through which these nutrients reduce the risk of cardiovascular disease, as observed in epidemiologic studies a nd several clinical trials. This article reviews clinical and experimental evidence regarding the role of these nutrients in modulating endothelial fu nction and their potential to prevent cardiovascular disease.