Title:Inflammation, Endothelial Dysfunction and Arterial Stiffness as Therapeutic Targets in Cardiovascular Medicine
Volume: 22
Issue: 30
Author(s): Vittoriano Della Corte, Antonino Tuttolomondo, Rosaria Pecoraro, Domenico Di Raimondo, Valerio Vassallo and Antonio Pinto
Affiliation:
Keywords:
Arterial stiffness, andothelial dysfunction, inflammation, atherosclerosis, pulse wave velocity, flow mediated dilation, low flow
mediated constriction, C reactive protein.
Abstract: In the last decades, many factors thought to be associated with the atherosclerotic
process and cardiovascular events have been studied, and some of these have been shown to
correlate with clinical outcome, such as arterial stiffness, endothelial dysfunction and immunoinflammatory
markers. Arterial stiffness is an important surrogate marker that describes
the capability of an artery to expand and contract in response to pressure changes. It can be
assessed with different techniques, such as the evaluation of PWV and AIx. It is related to
central systolic pressure and it is an independent predictor of cardiovascular morbidity and
mortality in hypertensive patients, type 2 diabetes, end-stage renal disease and in elderly
populations. The endothelium has emerged as the key regulator of vascular homeostasis, in
fact, it has not merely a barrier function but also acts as an active signal transducer for circulating
influences that modify the vessel wall phenotype. When its function is lost, it predisposes
the vasculature to vasoconstriction, leukocyte adherence, platelet activation, thrombosis
and atherosclerosis. Non-invasive methods were developed to evaluate endothelial function, such as the assesment
of FMD, L-FMC and RHI. Moreover in the last years, a large number of studies have clarified the role of
inflammation and the underlying cellular and molecular mechanisms that contribute to atherogenesis. For clinical
purposes, the most promising inflammatory biomarker appears to be CRP and a variety of population-based studies
have showed that baseline CRP levels predict future cardiovascular events. Each of the markers listed above
has its importance from the pathophysiological and clinical point of view, and those can also be good therapeutic
targets. However, it must be stressed that assessments of these vascular markers are not mutually exclusive, but
rather complementary and those can offer different views of the same pathology. The purpose of this review is to
analyze the role of arterial stiffness, endothelial dysfunction and immunoinflammatory markers as surrogate endpoint,
assessing the correlations between these markers and evaluating the therapeutic perspectives that these
offer.
