Endothelin in cardiovascular disease: from atherosclerosis to heart failure.

Since the discovery of endothelin (ET) as a potent vasoconstrictor, increasing evidence supports the role of ET in the pathogenesis of cardiovascular diseases including coronary artery disease and congestive heart failure. This peptide not only alters vascular tone and cardiac hemodynamics, but also has a substantial role in the regulation of cellular proliferation and apoptosis, activation of monocytes and cellular matrix production. Thus, ET may play a role in the pathogenesis of cardiovascular diseases through multiple mechanisms. The development of ET receptor antagonists has lead to a greater understanding of the role of the endogenous ET system in both physiologic and pathophysiologic states. Endothelin receptor antagonists are becoming new therapeutic tools for the treatment of cardiovascular disease and their study will lead to a greater understanding of the role of ET in disease progression.