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Two 4 Heart (24H)

 

The Foundation of Cardiovascular Health... the Endothelium

 The role of endothelial dysfunction in cardiovascular disease (CVD) is becoming more widely understood and emerging as the foundation of vascular health. The field of Vascular Medicine is growing, though most of us have only heard of the term endothelial dysfunction and certainly don’t know how to treat it. In fact, there are only a small handful of medical schools in the United States where vascular medicine is taught.

Most clinicians are taught little beyond the basic anatomy and histology of blood vessels. As a result, the focus of the field of cardiology has been on the heart as a pump, the vessels as pipes, and technological interventions such as stents, angioplasties, and bypasses in reducing blockages and symptoms rather than addressing the underlying problem, endothelial dysfunction.

Since 1900, cardiovascular disease (CVD) has been the number one killer in the United States (except for the 1918 pandemic flu). Despite all the technological advances, drug therapies, and interventions, CVD remains the number one killer. The culmination of 30 years of vascular health research shows us that treating endothelial dysfunction holds the answer in taking CVD off charts as the #1 killer.

What is the role of the endothelium?

The endothelium is the thin, one cell layer thick inner surface of all blood vessels. It is a very metabolically active organ with the surface area equivalent to that of 3 to 5 tennis courts. It is involved in regulating numerous processes including inflammation, vascular tone, coagulation, and oxidation. A healthy endothelium is a Teflon-like smooth, non-stick surface which is elastic and allows blood to flow freely within the blood vessels. An unhealthy endothelium is stiff, sticky like Velcro, causing platelets and white blood cells to adhere to it.

What role does Nitric Oxide and L-Arginine play in vascular health?

The breakthrough in vascular research came in the 1980’s when it was discovered that the endothelium produced nitric oxide. It was this production of nitric oxide that was responsible for the numerous functions in the vessels including vascular tone, coagulation, and inflammation. Dr. Salvador Moncada from England made another important discovery that the endothelium uses the amino acid L-arginine to make nitric oxide. Subsequent studies found that additional L-arginine could restore the ability of the blood vessels to dilate and become healthy. The culmination of this research around the world resulted in a Nobel Prize in Medicine for Dr. Louis Ignarro in 1998, specifically for the discovery of “nitric oxide as a signaling molecule in the cardiovascular system”.

Treating Endothelial Dysfunction

We now understand that endothelial dysfunction is the underlying pathology which leads to atherosclerosis, hypertension, coronary artery disease, heart failure, stroke, peripheral artery disease, and erectile dysfunction. Restoring healthy levels of nitric oxide is the key to treating endothelial dysfunction and reversing cardiovascular disease. Nobel Prize Laureate, Dr. Louis Ignarro also states, “Nitric Oxide influences the function of virtually every human organ, from the heart to the lungs to the stomach and can lower your risk of having a heart attack or stroke.”

John Cooke, MD, PhD, director of vascular medicine at Stanford University, wrote in his book “The Cardiovascular Cure” published in 2002: “The endothelium is so significant to blood vessel health that I predict that in the next few years the health of your endothelium will become as important as cholesterol to you and your doctor".