Endothelial dysfunction in coronary heart disease is more than a systemic process

This editorial refers to ‘Coronary endothelial dysfunction in patients with early coronary artery disease is associated with the increase in intravascular lipid core plaque,[†][1]’ by B.-J. Choi et al. , on page 2047 Since its initial description by our laboratory, now 27 years ago, much has been learned about the causes and consequences of human endothelial dysfunction.1 Impairment of endothelial function assessed by nitric oxide bioavailability (referred to as endothelial dysfunction) has been observed in atherosclerosis,1 is associated with traditional risk factors,2,3 and has been described in the setting of various systemic inflammatory disorders linked to high rates of coronary heart disease.4 Endothelial dysfunction exerts a key role in precipitating myocardial ischaemia during daily activities.2,3 Endothelial dysfunction confers adverse cardiovascular prognosis independently of known risk factors and also by becoming a pathophysiological target for both known and unknown cardiovascular risk factors.2 Fortunately, endothelial function can be restored with treatments that also improve long-term outcomes.2,3 Notably, failure of treatments to re-establish normal endothelial function among individuals with coronary heart disease or in individuals with hypertension identifies a subset of individuals who remain at high risk for adverse clinical events.5 Thus, endothelial function testing may ultimately be used to identify the non-responders and to individualize treatment with the purpose of preventing future clinical events.5 The pharmaceutical industry has recognized the importance of endothelial function testing as a tool for development of antiatherosclerotic drugs as endothelial function can change rapidly in response to interventions.6 Lastly, ‘endothelial biopsies’ which allow for the isolation of human endothelial cells are enabling investigators to characterize the biology of the endothelium on a molecular level. During this procedure, endothelial cells are removed from blood vessels using guidewires and analysed, for example, for protein … [1]: #fn-2