Heads and hearts: the endothelial connection.

Atherosclerosis is an inflammatory, proliferative, thrombotic arterial disease initiated by risk factor injury to the endothelium. Although obstructive plaques develop locally, the disease is always diffuse if examined by intravascular ultrasound or histology. Assessing and treating the initiating risk factors and the resulting obstructive disease has been the traditional approach to managing atherosclerosis. Our recent understanding of how the related pathophysiological processes of endothelial dysfunction and inflammation connect risk factors and disease expression has led to an interest in using these pathways to assess patient risk and determine therapies.1,2 In the future, we will also directly assess our genetic predisposition for developing and clinically manifesting atherosclerosis.