Noninvasive assessment of preclinical atherosclerosis.
Initially considered as a semipermeable barrier separating lumen from vessel wall, the endothelium is now recognised as a complex endocrine organ responsible for a variety of physiological processes vital for vascular homeostasis. These include the regulation of vascular tone, luminal diameter, and blood flow; hemostasis and thrombolysis; platelet and leucocyte vessel-wall interactions; the regulation of vascular permeability; and tissue growth and remodelling. The endothelium modulates arterial stiffness, which precedes overt atherosclerosis and is an independent predictor of cardiovascular events. Unsurprisingly, dysfunction of the endothelium may be considered as an early and potentially reversible step in the process of atherogenesis and numerous methods have been developed to assess endothelial status and large artery stiffness. Methodology includes flow-mediated dilatation of the brachial artery, assessment of coronary flow reserve, carotid intima/media thickness, pulse wave analysis, pulse wave velocity, and plethysmography. This review outlines the various modalities, indications, and limitations of available methods to assess arterial dysfunction and vascular risk.
Lane
Helen A
HA
Department of Endocrinology, University of Wales College of Medicine, Heath Park, Cardiff, Wales, UK. laneha@cf.ac.uk
Smith
Jamie C
JC
Davies
J Stephen
JS
D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D001779:Blood Coagulation Factors / Q000378:metabolism; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000209:etiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D017023:Coronary Angiography / Q000379:methods; D016207:Cytokines / Q000378:metabolism; D004548:Elasticity; D042783:Endothelial Cells / Q000473:pathology; D004730:Endothelium, Vascular / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008077:Lipoproteins, LDL / Q000378:metabolism; D010991:Plethysmography / Q000379:methods; D011674:Pulse; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D013234:Stem Cells / Q000473:pathology; D017539:Tunica Intima / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional / Q000379:methods; D014664:Vasodilation
D015415:Biomarkers; D001779:Blood Coagulation Factors; D016207:Cytokines; D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein