The Endothelium in Cardiovascular Disease : Pathophysiology, Clinical Presentation and Pharmacotherapy

The endothelium is an important regulator of the cardiovascular system by releasing nitric oxide, prostacyclin, endothelin-1, and other endothelium-derived constricting factors which are able to profoundly affect vascular tone and the function of circulating blood cells such as platelets and monocytes. In addition, the endothelium is a source of factors which can activate or inhibit vascular smooth muscle cell migration and proliferation. Endothelial dysfunction, with an imbalanced production of these factors, therefore, can profoundly affect vascular tone and structure as well as the function of circulating blood cells. Endothelial dysfunction has been demonstrated in various forms of cardiovascular diseasae. Cardiovascular drugs already in clinical use or in development are able to interfere with certain aspects of endothelial function and may be useful in protecting the vessels and, hence, in preventing the development of cardiovascular disease.