[The Role of Endothelial Function for Ischemic Manifestations of Coronary Atherosclerosis]

The vascular endothelium controls vasomotor tone by releasing a number of substances like nitric oxide (NO). NO has been shown to play a very important role, because it mediates vasodilation and furthermore inhibits platelet aggregation, expression of adhesion molecules for monocytes and adhesion of neutrophils and it impairs growth of vascular smooth muscle cells. An increased oxidative stress, decreasing the bioavailability of NO, is mainly responsible for a blunted endothelium dependent vasoreactivity. Risk factors for endothelial dysfunction are coronary artery disease, hypertension, hypercholesterolemia, smoking, and aging. Endothelial dysfunction in the presence of these risk factors might contribute to the occurrence of myocardial ischemia, aggravate acute coronary syndromes and accelerate progression of coronary artery disease. Amelioration of blunted endothelial function appears to be a major therapeutical goal to reduce ischemia and clinical events and might even retard progression of coronary artery disease.