Endothelial control of vasomotion and nitric oxide production.

This article has focused on the influence of NO. on vascular homeostasis. Vascular tone, however, is also influenced by other vasoactive factors released by the endothelium, including the endothelial-derived hyperpolarizing factors, prostacyclin, and vasoconstrictor factors. There is also abundant evidence that these factors are altered by pathophysiologic states, although the mechanisms responsible are not as well understood as they seem to be for the NO. system. There is now evidence that several endothelial-derived hyperpolarizing factors may exist. One is almost certainly the cytochrome p450 metabolite of arachidonic acid, epoxyeicosatrienoic acid (EET) [92], whereas another is likely H2O2, which stimulates potassium channel opening in a fashion similar to the EET [93]. EET has anti-inflammatory properties, whereas H2O2 may potentially enhance inflammation and promote vascular hypertrophy. Thus, two factors released by the endothelium with similar acute effects on the vascular smooth muscle may have very different long-term consequences in terms of protecting against or promoting vascular disease. During the past two decades, physicians have gained a substantial understanding of the L-arginine/eNOS/NO. pathway and how this modulates vascular reactivity. Further, physicians now are aware that this process is altered by many risk factors for atherosclerosis and have begun to understand how these disorders alter NO. production and bioavailability. These abnormalities are likely multifactorial and physicians are beginning to understand how they can be corrected. An exciting aspect of endothelial function is that it has prognostic significance above and beyond the traditional risk factors for atherosclerosis. Several studies now have shown that individuals with intact endothelial function in either the forearm or the coronary circulation have a low incidence of events during follow-up periods, whereas those individuals with abnormal endothelial function have a high incidence of major cardiovascular events [94-96]. Because of the complexity of abnormalities that underlie endothelial dysfunction, there are various therapeutic targets that may have to be addressed to improve endothelial function and ultimately improve prognosis in these individuals.