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Endothelial dysfunction: What all vascular diseases have in common. Prevent it.

Updated: Dec 6, 2022

What are endothelial cells

Endothelial cells are the cells that line the inner portion of the vascular system that is in regular contact with circulating blood [1].

Each artery has three layers that make up the sturdy vascular structure: the endothelial layer (which is in contact with circulating blood), the adventitia layer (outermost layer) and the medial layer (sandwiched between the endothelial and adventitia layers) [2].

What is the normal function of the endothelial layer?

The endothelial layer is considered the most important layer for the arteries. Endothelial cells are responsible for a number of different processes within the body:

  • Regulates fluid and molecular traffic between the circulating blood and surrounding tissues/organs [3]

  • Anticoagulant (anti-clotting) surface [3]

  • Contributes to vascular homeostasis and repair [3]

  • Promotes angiogenesis (the formation of new blood vessels) [3]

  • Aids wound healing [3]

  • Regulates vascular tone and local blood flow [3]

  • Production of important chemicals [3]

Endothelial function is one of the most essential functions within the cardiovascular system [3].

What causes endothelial dysfunction?

When these endothelial cells are damaged or not working correctly, endothelial dysfunction occurs [4].

Endothelial dysfunction is caused by:

  • Smoking [4]

  • Diabetes [5]

  • High blood pressure [4]

  • High cholesterol [1,4]

  • Weight gain [4]

  • Mental stress [4]

  • Excessive inflammation [4]

What makes endothelial dysfunction so dangerous?

Since endothelial cells have vital roles in the regulation of blood flow around the body, once their function has been compromised then, their ability to react and adapt to changing blood flow requirements considerably reduces [6].

As such, endothelial dysfunction can lead to the development of:

  • Hypertension [7]

  • Diabetes [5]

  • Sleep apnea [8]

  • Stroke [7]

  • Atherosclerosis [7]

  • Heart attack [6]

  • Periodontal disease [9]

  • Neurodegenerative diseases, such as Alzheimers [10]

  • Peripheral artery disease [11]

  • Renal failure [12]

  • Portal hypertension [13]

  • Angina [14]

  • Pulmonary hypertension [15]

These vascular diseases originate from the reduced capacity of the endothelial layer to change, react and return to normal blood flow. In addition, once the process of endothelial dysfunction starts, it exacerbates the formation of these pathologies [7].

How do we prevent endothelial dysfunction?

To prevent endothelial dysfunction, we can:

  • Exercise [1]

  • Weight loss [1]

  • Stress reduction [4]

  • Cholesterol-lowering medication [1]

How do we measure endothelial dysfunction?

Endothelial dysfunction can be measured by your doctors. They will usually tend to use a blood pressure cuff to stop the blood flow into your lower arm and use an ultrasound device to measure the blood flows response when the cuff is released, and blood is allowed to flow [16].

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[1] Man AWC, Li H, Xia N. Impact of Lifestyles (Diet and Exercise) on Vascular Health: Oxidative Stress and Endothelial Function. Oxidative Medicine and Cellular Longevity. 2020;2020:1496462.

[2] Brown IAM, Diederich L, Good ME, Delalio LJ, Murphy SA, Cortese-Krott MM, et al. Vascular Smooth Muscle Remodeling in Conductive and Resistance Arteries in Hypertension. Arteriosclerosis, Thrombosis, and Vascular Biology. 2018;38(9):1969-85.

[3] Pearson JD. Normal endothelial cell function. Lupus. 2000;9(3):183-8.

[4] Esper RJ, Nordaby RA, Vilariño JO, Paragano A, Cacharrón JL, Machado RA. Endothelial dysfunction: a comprehensive appraisal. Cardiovascular Diabetology. 2006;5(1):4.

[5] Takeda Y, Matoba K, Sekiguchi K, Nagai Y, Yokota T, Utsunomiya K, et al. Endothelial Dysfunction in Diabetes. Biomedicines. 2020;8(7):182.

[6] Zuchi C, Tritto I, Carluccio E, Mattei C, Cattadori G, Ambrosio G. Role of endothelial dysfunction in heart failure. Heart Failure Reviews. 2020;25(1):21-30.

[7] Vanhoutte PM, Shimokawa H, Tang EHC, Feletou M. Endothelial dysfunction and vascular disease. Acta Physiologica. 2009;196(2):193-222.

[8] Budhiraja R, Parthasarathy S, Quan SF. Endothelial Dysfunction in Obstructive Sleep Apnea. Journal of Clinical Sleep Medicine. 2007;03(04):409-15.


[10] Kelleher RJ, Soiza RL. Evidence of endothelial dysfunction in the development of Alzheimer's disease: Is Alzheimer's a vascular disorder? Am J Cardiovasc Dis. 2013;3(4):197-226.

[11] Brevetti G, Schiano V, Chiariello M. Endothelial dysfunction: A key to the pathophysiology and natural history of peripheral arterial disease? Atherosclerosis. 2008;197(1):1-11.

[12] Santoro D, Bellinghieri G, Conti G, Pazzano D, Satta E, Costantino G, et al. Endothelial Dysfunction in Chronic Renal Failure. Journal of Renal Nutrition. 2010;20(5, Supplement):S103-S8.

[13] Iwakiri Y. Endothelial dysfunction in the regulation of cirrhosis and portal hypertension. Liver International. 2012;32(2):199-213.

[14] TERAGAWA H, KATO M, KUROKAWA J, YAMAGATA T, MATSUURA H, CHAYAMA K. Endothelial dysfunction is an independent factor responsible for vasospastic angina. Clinical Science. 2001;101(6):707-13.

[15] Budhiraja R, Tuder RM, Hassoun PM. Endothelial Dysfunction in Pulmonary Hypertension. Circulation. 2004;109(2):159-65.

[16] Königstein K, Wagner J, Frei M, Knaier R, Klenk C, Carrard J, et al. Endothelial function of healthy adults from 20 to 91 years of age: prediction of cardiovascular risk by vasoactive range. J Hypertens. 2021;39(7):1361-9.


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