In this presentation Dr. Fichtlscherer talks about endothelial function in relation to C-reactive protein (CRP), a marker of systemic inflammation.

Endothelial dysfunction plays a key part in vascular disease, and Dr. Fichtlscherer describes the process of inflammatory endothelial activation, resulting in vasoconstriction and other harmful effects. Acute systemic inflammation has been found to impair endothelium-dependent dilatation in humans (1), and associations between elevated CRP and endothelial dysfunction have been observed in different types of individuals such as those with coronary artery disease (2), healthy children (3) and those with coronary risk factors (4).

Endothelial dysfunction has further been found to predict future cardiovascular events in patients at risk or with stable or unstable coronary artery disease (5). Dr. Fichtlscherer also talks about the clinical assessment of local and systemic endothelial function, and ends with some concluding comments.

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After viewing this presentation the participant will be able to discuss:

- Effects of inflammatory endothelial activation
- Clinical assessment of local vs. systemic endothelial function
- Associations between elevated CRP and endothelial dysfunction
- Endothelial dysfunction as a predictor of future cardiovascular events

1. Aroon D. Hingorani, PhD, MRCP; Jenny Cross, BSc, MRCP; Rajesh K. Kharbanda, BSc, MRCP; Michael J. Mullen, MBBS, MRCP; Kiran Bhagat, PhD, MRCP; Mia Taylor, BSc; Ann E. Donald; Miriam Palacios, PhD; George E. Griffin, MD, FRCP; John E. Deanfield, MB, BChir, FRCP; Raymond J. MacAllister, MD, MRCP; Patrick Vallance, MD, FRCPAcute Systemic Inflammation Impairs Endothelium-Dependent Dilatation in Humans Circulation. 2000;102:994.

2. Stephan Fichtlscherer, MD; Gunter Rosenberger, MD; Dirk H. Walter, MD; Susanne Breuer, MD; Stefanie Dimmeler, PhD; Andreas M. Zeiher, MDElevated C-Reactive Protein Levels and Impaired Endothelial Vasoreactivity in Patients With Coronary Artery Disease Circulation. 2000;102:1000.

3. Mikko J. Järvisalo; Aimo Harmoinen; Maarit Hakanen; Ulla Paakkunainen; Jorma Viikari; Jaakko Hartiala; Terho Lehtimäki; Olli Simell; Olli T. Raitakari. Elevated Serum C-Reactive Protein Levels and Early Arterial Changes in Healthy Children Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22:1323.

4. Thomas H. Schindler, MD; Egbert U. Nitzsche, MD; Manfred Olschewski, MSc; Nobuhisa Magosaki, MD; Michael Mix, PhD; John O. Prior, MD PhD; Alvaro D. Facta, MD; Ulrich Solzbach, MD; Hanjoerg Just, MD; Heinrich R. Schelbert, MD PhDChronic Inflammation and Impaired Coronary Vasoreactivity in Patients With Coronary Risk Factors Circulation. 2004;110:1069-1075.

5. Peter Ganz, MD; Joseph A. Vita, MDTesting Endothelial Vasomotor Function: Nitric Oxide, a Multipotent MoleculeCirculation. 2003;108:2049.

Further reading:

6. Fichtlscherer S, Breuer S, Zeiher AM. Prognostic value of systemic endothelial dysfunction in patients with acute coronary syndromes: further evidence for the existence of the "vulnerable" patient. Circulation. 2004 Oct 5;110(14):1926-32.

7. Fichtlscherer S, Breuer S, Schaechinger V, Dimmeler S, Zeiher AM. C-reactive protein levels determine systemic nitric oxide bioavailability in patients with coronary artery disease. Eur Heart J. 2004 Aug;25(16):1412-8.

8. Fichtlscherer S, Breuer S, Heeschen C, Dimmeler S, Zeiher AM. . Interleukin-10 serum levels and systemic endothelial vasoreactivity in patients with coronary artery disease. Journal of the American College of Cardiology. 2004 Jul 7;44(1):44-9.

9. Fichtlscherer S, Heeschen C, Zeiher AM. Inflammatory markers and coronary artery disease. Current Opinion in Pharmacology. 2004 Apr;4(2):124-31.

10. Fichtlscherer S, Roessig L, Breuer S, Vasa M, Dimmeler S, Zeiher AM. Tumor necrosis factor antagonism with etanercept improves systemic endothelial vasoreactivity in patients with advanced heart failure. Circulation. 2001 Dec 18;104(25):3023-5.

11. Fichtlscherer S, Zeiher AM. Endothelial dysfunction in acute coronary syndromes: association with elevated C-reactive protein levels. Ann Med. 2000 Nov;32(8):515-8.

12. Schaechinger V, Britten MB, Zeiher AM. Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation. 2000 Apr 25;101(16):1899-906.