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The Effect of Cardiovascular Risk Factors on the Coronary Circulation

Effects of Cardiovascular Risk Factors on Coronary Circulation: Hypertension, Diabetes, Dyslipidemia

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Physiological Assessment of Coronary Stenoses and the Microcirculation

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Abstract

The atherosclerotic plaque and its limitation to normal coronary blood flow constitute the more evident effect of traditional cardiovascular risk factors on the endothelium of epicardial coronary arteries. However, at an early stage, risk factors may cause coronary microvascular dysfunction through both an endothelial-dependent and independent mechanisms. Hypertension, dyslipidemia, and diabetes mellitus may contribute to endothelial dysfunction (ED) due to the generation of oxidative stress, mainly through NADPH oxidases upregulation and uncoupled endothelial nitric oxide synthase. ED can be regarded as the risk of the risk factors. ED is a predominantly functional first manifestation of atherosclerosis, but it is also essential in the pathogenesis of atherosclerosis because it contributes to the initiation and evolution of prothrombotic, proinflammatory and proliferative states. ED may be regarded as an integrated index of all atherogenic and atheroprotective factors present in an individual, including unknown factors and genetic predisposition, and has been shown to be reversible with appropriate intervention. Thus, it may be a potentially useful clinical strategy to consider endothelial function in the assessment of early atherosclerosis not only to predict and prevent atherosclerotic complications but also to determine the efficacy of current ongoing and future therapeutic options. Testing, targeting and treating ED can be looked as doing so with the atherosclerotic process itself.

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Abbreviations

ADMA:

Asymmetric dimethylarginine

Ach:

Acetylcholine

CAD:

Coronary artery disease

CBF:

Coronary blood flow

CFR:

Coronary flow reserve

CHD:

Coronary heart disease

CMD:

Coronary microvascular dysfunction

CV:

Cardiovascular

CVRF:

Cardiovascular risk factors

ED:

Endothelial dysfunction

EDCF:

Endothelium-derived contracting factor

EDRF:

Endothelium-derived relaxing factor

EF:

Endothelial function

eNOS:

Endothelial nitric oxide synthase

FMD:

Flow-mediated vasodilation

LVH:

Left ventricular hypertrophy

MBF:

Myocardial blood flow

NO:

Nitric oxide

RH-PAT:

Reactive hyperemia-peripheral artery tonometry

ROS:

Reactive oxygen species

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  1. Endovascular Unit, Heart Center, Virgen Macarena Hospital, Seville, Spain

    Luis Felipe Valenzuela-García, Yasushi Matsuzawa & Amir Lerman

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    Javier Escaned

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    Justin Davies

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Valenzuela-García, L.F., Matsuzawa, Y., Lerman, A. (2017). The Effect of Cardiovascular Risk Factors on the Coronary Circulation. In: Escaned, J., Davies, J. (eds) Physiological Assessment of Coronary Stenoses and the Microcirculation. Springer, London. https://doi.org/10.1007/978-1-4471-5245-3_6

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