Review Clinical impact of vasomotor function assessment and the role of ACE-inhibitors and statins Folkert W. Asselbergs a,b, T , Pim van der Harst a,b , Gillian A.J. Jessurun b , Rene ´ A. Tio b , Wiek H. van Gilst a,b a Department of Clinical Pharmacology, University of Groningen, Groningen, The Netherlands b Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands Abstract Impaired endothelial function is recognised as one of the earliest events of atherogenesis. Endothelium-dependent vasomotion has been the principal method to assess endothelial function. In this article, we will discuss the clinical value of the different techniques to evaluate endothelium-dependent vasomotion. To date, there seems not to be a simple and reliably endothelial function test to identify asymptomatic subjects at increased risk for cardiovascular disease in clinical practice. Recent studies indicate that pharmacological interventions, in particular with ACE-inhibitors and statins, might improve endothelial function. However, there is no solid evidence that improvement of endothelial function is a necessity for the observed reduction in cardiovascular events by these compounds. Overall, at this moment, there is no place in clinical practice for the use of endothelial function as a method for risk assessment or target of pharmacological interventions. D 2005 Elsevier Inc. All rights reserved. Keywords: Endothelial function; Acetylcholine; Risk factors; Prognosis; ACE-inhibitors; Statins Contents 1. Introduction ........................................................... 125 2. Endothelial dependent vasomotor function ........................................... 126 3. Assessment of endothelium-dependent vasomotor function................................... 127 4. Prognostic value of endothelium-dependent vasomotor function ................................ 128 5. Intervention on endothelium-dependent vasomotor function .................................. 130 5.1. Hypertension, ACE-inhibitors, and endothelium-dependent vasomotor function .................... 130 5.2. Effects of cholesterol lowering therapy and HMG CoA reductase inhibitors on endothelium-dependent vasomotor function ................................................... 131 5.3. Clinical implications of therapeutic interventions on endothelial dependent vasomotor function ............ 133 6. Conclusions ........................................................... 134 Acknowledgements ......................................................... 134 References .............................................................. 134 1. Introduction Since the discovery of the obligatory role for the endothelium in relaxing arterial smooth muscles by acetyl- choline in 1980(Furchgott and Zawadzki, 1980), the 1537-1891/$ - see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.vph.2005.01.009 T Corresponding author. Department of Clinical Pharmacology, Univer- sity of Groningen, Groningen, The Netherlands. Tel.: +31 503632810; fax: +31 503632812. E-mail address: f.w.asselbergs@thorax.azg.nl (F.W. Asselbergs). Vascular Pharmacology 42 (2005) 125–140 www.elsevier.com/locate/vph