Endothelial dysfunction and coronary artery disease: assessment, prognosis, and treatment.
Endothelial dysfunction and coronary artery disease: assessment, prognosis, and treatment.
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DOI：
10.1097/mca.0000000000000178
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发表时间：
2014-12
影响因子：
1.8
通讯作者：
Lerman A
中科院分区：
文献类型：
--
作者：
Matsuzawa Y;Lerman A
传统冠状动脉危险因素和生活方式改变的进展降低了动脉粥样硬化性冠状动脉疾病的发病率，但它仍然是世界上主要的死亡原因。这可能与冠心病危险分层和预防策略的缺陷有关。动脉粥样硬化性冠状动脉疾病风险的估计基于当前临床环境中仅识别和量化传统风险因素，不考虑非传统风险因素。此外，大多数动脉粥样硬化的流行疗法针对的是传统的危险因素，而不是动脉粥样硬化本身。希望有一种方法，可以直接评估动脉粥样硬化形成的活动在每一个时刻。内皮功能是个体中存在的所有致动脉粥样硬化和动脉粥样硬化保护因素的综合指数，包括非传统和迄今未知的因素，并且据报道对传统危险因素具有未来心血管事件的额外预测价值。此外，内皮功能在动脉粥样硬化的所有阶段都起着关键作用，从开始到动脉粥样硬化血栓形成并发症，并且在每个阶段都是可逆的，这表明内皮功能指导的治疗在心血管实践中可能是有效和可行的。因此，将内皮功能检测引入临床实践可能使我们能够创新个性化的心血管药物。在这篇综述中，我们总结了目前的知识，内皮功能障碍的贡献动脉粥样硬化和审查方法，评估内皮功能。最后，我们重点讨论了抗动脉粥样硬化疾病的主要治疗方法对内皮功能的影响，并讨论了无创评估内皮功能的可能性，旨在个性化的心血管药物。
Progress in modification of conventional coronary risk factors and lifestyle behavior reduced atherosclerotic coronary artery disease incidence, nonetheless it continues to be the leading cause of mortality in the world. It might be attributed to the defective risk stratifying and prevention strategy for coronary artery disease. Atherosclerotic coronary artery disease risk is estimated based on identifying and quantifying only traditional risk factors in current clinical settings, it does not consider non-traditional risk factors. In addition, most of prevailing therapies for atherosclerosis are targeted for traditional risk factors rather than atherosclerosis itself. It is desirable to have a methodology which can directly assess the activity of atherogenesis at each moment. Endothelial function is an integrated index of all atherogenic and atheroprotective factors present in an individual including non-traditional and heretofore unknown factors, and is reported to have additional predictive value for future cardiovascular events to traditional risk factors. Moreover, endothelial function has a pivotal role in all phases of atherosclerosis, from initiation to atherothrombotic complication, and is reversible at every phase, indicating that endothelial function-guided therapies might be effective and feasible in cardiovascular practice. Thus, the introduction of endothelial function testing into clinical practice might enable us to innovate individualized cardiovascular medicine. In this review, we summarize the current knowledge on the contribution of endothelial dysfunction to atherogenesis and review methods that assess endothelial function. Finally we focus on the effects of major anti-atherosclerotic disease therapies on endothelial function, and argue the possibility of non-invasive assessment of endothelial function aiming at individualized cardiovascular medicine.