Book Review
Endothelial Dysfunctions and Vascular Disease
N Engl J Med 2008; 358:976-977February 28, 2008
- Article
Endothelial Dysfunctions and Vascular Disease
Edited by Raffaele De Caterina and Peter Libby. 416 pp., illustrated. Malden, MA, Blackwell Futura, 2007. $134.95. ISBN: 978-1-4051-2208-5The vascular endothelium is a metabolically active organ system that helps to maintain vascular homeostasis. In addition to being an anatomical barrier that prevents the influx of circulating blood into the vessel wall, the endothelium modulates vascular tone, regulates local cellular growth and the deposition of extracellular matrix, protects the vessel from the potentially harmful consequences of toxic substances and cells that circulate in the blood, and mediates hemostatic, inflammatory, and reparative responses to local injury. Conditions such as hypercholesterolemia, systemic hypertension, diabetes, problems that are caused by smoking, and estrogen deficiency are associated with endothelial dysfunction, which may promote inflammation, oxidation of lipoproteins, proliferation of smooth-muscle cells, deposition or lysis of extracellular matrix, accumulation of lipid-rich material, activation of platelets (which promotes clotting), and thrombus formation. Thus, endothelial dysfunction may contribute to atherosclerosis and coronary heart disease.
Endothelial Dysfunctions and Vascular Disease is a timely book with contributions from many experts. It covers broad areas, from the basis and diagnosis of endothelial dysfunction and vascular disease to therapeutics. To help the general medical reader, the authors provide helpful illustrations, figures, and references.
The book begins with a comprehensive review of the mechanisms of atherosclerosis, risk factors that are associated with endothelial dysfunction, methods for the early diagnosis of endothelial dysfunction, and treatments that are aimed at improving impaired endothelial function. Following the discussions of these general topics are sections under subheadings that provide more detailed information.
If there are any flaws in this excellent book, they lie in the absence of some current and controversial topics. For example, there is no detailed discussion of emerging risk factors, such as obesity, the metabolic syndrome, and hypertension, and detailed explanations of potential biomarkers, such as obesity-related adipocytokines and hemostasis, are missing. There is little information regarding diet, exercise, cessation of smoking, or combination treatment with different classes of drugs. Limited space is devoted to the interactions of multiple risk factors that would support the decision to give combination treatment, an important and promising therapeutic approach. The book also fails to cover recent studies that demonstrate reciprocal relationships between endothelial dysfunction and insulin resistance, a connection that may have important therapeutic implications.
Nonetheless, this compendium is recommended for physicians who are interested in a practical and succinct overview of endothelial dysfunction and vascular disease.
Kwang Kon Koh, M.D., Ph.D.
Gachon University Gil Medical Center, 405-760 Incheon, Korea
kwangk@gilhospital.com
