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Bedeutung der Endothelfunktion für ischämische Manifestationen der koronaren Atherosklerose

Role of endothelial function for ischemic manifestations of coronary atherosclerosis

  • Koronare Atherosklerose — Funktionelle Konsequenzen
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Zusammenfassung

Das Endothel kontrolliert den Vasotonus über eine Reihe von parakrinen Mediatoren. Stickstoffmonoxid (NO) spielt hierbei eine zentrale Rolle. Es wirktt nicht nur vasodilatorisch, sondern gleichzeitig antiaggregatorisch, antiinflammatorisch sowie antiproliferativ. Risikofaktoren für die Entstehung einer Endotheldysfunktion sind unter anderem die koronare Herzerkrankung, die Hypertonie, Hypercholesterinämie, Nikotinkonsum sowie ein erhöhtes Lebensalter. Hierbei spielt die reduzierte Bioverfügbarkeit von NO durch erhöhten oxidativen Streß eine große Rolle. Hieraus resultierende Störungen der endothelabhängigen Vasoreaktivität können zu inadäquater Versorgung des Myokards mit Sauerstoff führen. So kann eine Endotheldysfunktion sowohl zur Entstehung von klinisch stabiler Angina pectoris beitragen als auch den klinischen Verlauf akuter koronarer Syndrome beeinflussen. Die weitere klinische und molekulare Erforschung der zugrundeliegenden Pathomechanismen kann in Zukunft dazu führen, therapeutisch das Fortschreiten und möglicherweise auch die Entstehung der koronaren Herzerkrankung zunehmend zu beeinflussen.

Summary

The vascular endothelium controls vasomotor tone by releasing a number of substances like nitric oxide (NO). NO has been shown to play a very important role, because it mediates vasodilation and furthermore inhibits platelet aggregation, expression of adhesion molecules for monocytes and adhesion of neutrophils and it impairs growth of vascular smooth muscle cells. An increased oxidative stress, decreasing the bioavailability of NO, is mainly responsible for a blunted endothelium dependent vasoreactivity. Risk factors for endothelial dysfunction are coronary artery disease, hypertension, hypercholesterolemia, smoking, and aging. Endothelial dysfunction in the presence of these risk factors might contribute to the occurrence of myocardial ischemia, aggravate acute coronary syndromes and accelerate progression of coronary artery disease. Amelioration of blunted endothelial function appears to be a major therapeutical goal to reduce ischemia and clinical eyents and might even retard progression of coronary artery disease.

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  1. Medizinische Klinik IV, Schwerpunkt Kardiologie, Johann-Wolfgang-Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt

    Martina Britten & Volker Schächinger

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  1. Martina Britten
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Britten, M., Schächinger, V. Bedeutung der Endothelfunktion für ischämische Manifestationen der koronaren Atherosklerose. Herz 23, 97–105 (1998). https://doi.org/10.1007/BF03044540

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