Assessing endothelial function as a risk factor for cardiovascular disease.

The vascular endothelium plays a key role in the prevention of atherosclerosis. Endothelial dysfunction is an antecedent of clinical cardiovascular disease and can be viewed as the final pathway between coronary risk factors and the development of atherosclerosis. The development of a noninvasive method of assessing endothelial health (ie, measurement of flow- mediated dilation of the brachial artery) has enabled investigators to evaluate the effects of dietary patterns on vascular function. Emerging evidence indicates that dietary fats may acutely impair endothelial function, but this effect is dependent on the type of fat and on the other nutrients consumed. Although inconclusive, studies in cohorts of modest size suggest that antioxidants, L-arginine, and folic acid may modulate endothelial function. Additional research is needed to define the impact of complex, long-term dietary patterns on the vascular endothelium.