Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905, USA.
Biomark Med. 2010 Jun;4(3):351-60. doi: 10.2217/bmm.10.61.
Traditional cardiovascular risk (CV) factors based on the Framingham study have been used to estimate the risk of CV events and determine target cholesterol levels for primary prevention. Recently published systematic reviews have, however, demonstrated that the Framingham risk score is limited in certain cohorts and requires adjustment. Indeed, traditional CV risk factors fail to predict the development of coronary heart disease in 25-50% of cases. This underscores the complex interplay between traditional CV risk factors, genetic predisposition and other atheroprotective factors present in individuals of different populations in predicting CV events. Endothelial dysfunction, a functional expression of the inherent atherosclerotic risk representing an integrated index of both the overall CV risk-factor burden and the sum of all vasculoprotective factors in an individual, may serve as the missing link between CV risk factors and atherosclerotic disease. Endothelial function measurements may aid in future prediction of CV events and help identify high-risk patients for targeted therapy as well as provide a primary therapeutic end point for clinical follow-up of these patients. Recently introduced reactive hyperemia peripheral arterial tonometry is emerging as a promising tool in endothelial function measurement and CV risk stratification.
传统的心血管风险（CV）因素基于弗雷明汉研究，用于估计 CV 事件的风险，并确定初级预防的目标胆固醇水平。然而，最近发表的系统评价表明，弗雷明汉风险评分在某些队列中受到限制，需要进行调整。事实上，传统的心血管危险因素不能预测 25-50%的病例中冠心病的发生。这突显了传统心血管危险因素、遗传易感性和不同人群中其他动脉保护因素之间的复杂相互作用，这些因素在预测心血管事件中起着重要作用。内皮功能障碍是内在动脉粥样硬化风险的功能性表达，代表了个体整体心血管危险因素负担和所有血管保护因素总和的综合指数，可能是心血管危险因素与动脉粥样硬化疾病之间缺失的环节。内皮功能测量可能有助于未来预测 CV 事件，并有助于识别高危患者进行靶向治疗，以及为这些患者的临床随访提供主要治疗终点。最近引入的反应性充血外周动脉张力测定法作为内皮功能测量和 CV 风险分层的一种很有前途的工具正在出现。
