Endothelial dysfunction – The Root Cause of Cardiovascular Disease
The latest findings on cardiovascular disease suggest that endothelial dysfunction is at the “heart” of cardiovascular disease. The endothelium is probably the largest and most extensive tissue in the body. It is an uninterrupted, smooth and nonthrombogenic surface that forms a highly selective barrier and makes and releases a wide variety of substances.
Endothelial dysfunction is a systemic pathological state of the endothelium which is the lining of the blood vessels. It is an imbalance between vasodilating and vasoconstricting substances produced by or acting on the endothelium. The cells that line the arteries – endothelial cells – have many different functions. These include mediation of coagulation or clotting, platelet adhesion, immune function, control of volume and electrolyte content of the intravascular and extravascular spaces.
Endothelial dysfunction is considered to be a key event in the development of atherosclerosis or hardening of the arteries and plaque build-up. A key feature of endothelial dysfunction is the inability of the arteries to dilate fully in response to an appropriate stimulus. Normally a stimulus would cause the release of vasodilators from the endothelium such as nitric oxide. With endothelial dysfunction, there is most often a decreased availability of nitric oxide. Without nitric oxide, there can be no dilation. Nitric oxide has anti-inflammatory and anti-proliferative effects which is why it helps to inhibit atherosclerosis.
Endothelial function can be improved significantly by exercise and improved diet. A study in the 2005 Journal of Nutrition found a positive relationship existed between the consumption of trans fat, commonly found in hydrogenated products such as margarine, and the development of endothelial dysfunction. Other factors have been identified as improving endothelial function including smoking cessation, loss of weight, treatment of hypertension and hypercholesterolemia and supplementation with antioxidants and arginine.