ROLE OF ENDOTHELIAL DYSFUNCTION IN CARDIOVASCULAR SYSTEM PATHOLOGY
The literature review focuses on the role of endothelial dysfunction in cardiovascular diseases: hypertension, atherosclerosis, coronary heart disease, and chronic heart failure. The purpose of the review is to determine the role of endothelial dysfunction in the pathogenesis of these diseases. The endothelium is considered as a single paracrine organ distributed over the entire surface of the human body. Endothelium functioning under physiological conditions and factors affecting its functioning are analyzed. The production of multidirectional mediators (including nitric oxide) by endothelial cells and their functions is revealed. Nitric oxide is presented as a universal key angioprotective factor and an anti-atherosclerotic agent. The crucial role of the hemodynamic factor in the production of nitric oxide in the initial stages of hypertension is revealed. The process of nitric oxide synthesis, intermediate substance formation and their effect on the vessels is described. The modulating effect of nitric oxide on other mediators, its role in remodeling regulation and the development of atherosclerotic changes in the vascular wall is established. The endothelium reaction to decrease in nitric oxide production in response to factors leading to endothelium damage is considered. The role of other vasodilating agents in case of decrease in nitric oxide level is revealed, e.g., the role of angiotensin II, which has a powerful vasoconstrictor effect on arterial vessels, stimulates the cytokine production and, thus, initiates an inflammatory process in vascular walls. Some pharmacological and drug-free ways to improve endothelium functions are considered.