Swedberg K B
Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden.
Am J Cardiol. 1998 Aug 6;82(3A):8H-14H. doi: 10.1016/s0002-9149(98)00485-8.
Several independent predictors of the risk of atherosclerosis are known including plasma cholesterol concentration, cigarette smoking, elevated blood pressure, as well as genetic factors such as non-insulin-dependent diabetes and plasma fibrinogen. Also known are the 3 major elements of the pathogenesis of atherosclerosis, involving modification of endothelial function, changes in vascular tone, and clinical sequelae of hyperplasia of smooth muscle cells in the intima of the affected blood vessels. This article further examines vasoconstrictor/vasodilator balance, the role of angiotensin II, and the significant role played by the endothelium in the complex events and interactions that occur both with smooth muscle cells and platelets. Clinical evidence of endothelial dysfunction in coronary artery disease is presented. The importance of the association of the progression of coronary artery disease with signs of neuroendocrine activation, the relation of endothelin-1 to mechanisms of neuroendocrine activation, and how the counteraction of this activation may have beneficial effects on disease progression are discussed.
已知动脉粥样硬化风险的几个独立预测因素，包括血浆胆固醇浓度、吸烟、血压升高，以及诸如非胰岛素依赖型糖尿病和血浆纤维蛋白原等遗传因素。动脉粥样硬化发病机制的3个主要要素也为人所知，包括内皮功能的改变、血管张力的变化，以及受累血管内膜平滑肌细胞增生的临床后果。本文进一步探讨血管收缩剂/血管舒张剂平衡、血管紧张素II的作用，以及内皮在与平滑肌细胞和血小板发生的复杂事件及相互作用中所起的重要作用。文中还介绍了冠状动脉疾病中内皮功能障碍的临床证据。讨论了冠状动脉疾病进展与神经内分泌激活迹象之间关联的重要性、内皮素-1与神经内分泌激活机制的关系，以及这种激活的对抗作用如何可能对疾病进展产生有益影响。
