Die Kardiologen und die Zukunft ihres Fachs

Viewpoint Zur Frage der Zertifizierung von Spezialfächern der Kardiologie Die Kardiologen und die Zukunft ihres Fach

Endothelial Regulation of Vascular Tone and Growth

The endothelium regulates vascular tone by releasing factors involved in relaxation and contraction, in coagulation and thrombus formation, and in growth inhibition and stimulation. Endothelium-dependent relaxations are elicited by transmitters, hormones, platelet substances, and the coagulation system, and by physical stimuli such as the shear stress from circulating blood. They are mediated by the endothelium-derived relaxing factor, recently identified as nitric oxide, which causes vasodilation and platelet deactivation. Other proposed endothelium- derived relaxing factors include a hyperpolarizing factor, lipooxygenase products, and the cytochrome P450 pathway. Endothelium-derived contracting factors are produced by the cyclooxygenase pathway and by endothelial cells, which produce the peptide endothelin-1, a potent vasoconstrictor that under normal conditions circulates at low levels. The endothelium produces both growth inhibitors— normally dominant—and growth stimuli. Denuded or dysfunctional endothelium leads to a proliferative response and intimal hyperplasia in the vessel wall; moreover, platelets adhere to the site and release potent growth factors. Endothelial dysfunction has numerous causes: Aging is associated with increased formation of contracting factor and decreased relaxing factor; denudation, such as by coronary angioplasty, impairs the capacities of regenerated endothelial cells; oxidized low-density lipoproteins and hypercholesterolemia interfere with nitric oxide production; hypertension morphologically and functionally alters the endothelium; and atherosclerosis markedly attenuates some endothelium- dependent relaxations. For patients with coronary bypass grafts, differences in endotheliumderived vasoactive factors between the internal mammary artery and the saphenous vein may be important determinants of graft function, with the mammary artery having more pronounced relaxations than the saphenous vein and thus a higher patency rate. Am J Hypertens 1993;6:283S-293

Inflammation and cardiovascular diseases: lessons from seminal clinical trials.

Abstract Inflammation has been long regarded as a key contributor to atherosclerosis. Inflammatory cells and soluble mediators play critical roles throughout arterial plaque development and accordingly, targeting inflammatory pathways effectively reduces atherosclerotic burden in animal models of cardiovascular (CV) diseases. Yet, clinical translation often led to inconclusive or even contradictory results. The Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS) followed by the Colchicine Cardiovascular Outcomes Trial (COLCOT) were the first two randomized clinical trials to convincingly demonstrate the effectiveness of specific anti-inflammatory treatments in the field of CV prevention, while other phase III trials—including the Cardiovascular Inflammation Reduction Trial one using methotrexate—were futile. This manuscript reviews the main characteristics and findings of recent anti-inflammatory Phase III trials in cardiology and discusses their similarities and differences in order to get further insights into the contribution of specific inflammatory pathways on CV outcomes. CANTOS and COLCOT demonstrated efficacy of two anti-inflammatory drugs (canakinumab and colchicine, respectively) in the secondary prevention of major adverse CV events (MACE) thus providing the first confirmation of the involvement of a specific inflammatory pathway in human atherosclerotic CV disease (ASCVD). Also, they highlighted the NOD-, LRR-, and pyrin domain-containing protein 3 inflammasome-related pathway as an effective therapeutic target to blunt ASCVD. In contrast, other trials interfering with a number of inflammasome-independent pathways failed to provide benefit. Lastly, all anti-inflammatory trials underscored the importance of balancing the risk of impaired host defence with an increase in infections and the prevention of MACE in CV patients with residual inflammatory risk

Nifedipine inhibits superoxide production induced by pulsatile stretch in human aortic endothelial cells

Dihydropiridine calcium channel blocker nifedipine restores nitric oxide-mediated vasodilation in human hypertension. The mechanims involved have not been fully characterized but may relate to endothelial protection. Mechanical forces such as pulsatile stretch are involved in superoxide anion production. To clarify the effect of nifedipine on the balance between nitric oxide and superoxide anion, human cultured aortic endothelial cells were exposed to pulsatile stretch in the presence and in the absence of this compound. Rhytmic stretching was given for 1 hour by a computerized Flexercell strain unit (10% average elongation, 50 cycles per minute). Superoxide anion production was measured as the superoxide dismutase-inhibitable reduction of cytochrome c. Stretch-induced production of superoxide anion was inhibited in a concentration-dependent manner by nifedipine [6.2±0.9 vs 2.1±0.6* and 4.8±0.4*, 2.4±0.5* nmol/60 min/105 cells for stretch vs control and stetch plus nifedipine (10−7 and 10−6 M), respectively; n=6; *P<0.05 vs stretch]. This antioxidant activity of nifedipine may exert vascular protective effects in human endothelial cells. Thus, nifedipine may affect mechanical forces which, as determinants of the balance between nitric oxide and superoxide anion, are likely to play a key role in the pathophysiology of hypertensive vascular diseas