Glycocalyx measurements in people with premature cardiovascular disease.

Atherosclerosis is currently the leading cause of death and disability in the developed world, often causing myocardial and cerebral infarction, kidney failure and peripheral arterial occlusive disease. Atherosclerosis is considered to be a chronic inflammatory response of the arterial wall, initiated by injury of the endothelium. The cause of this injury is unknown, but several factors, like hyperlipidemia, hypertension, smoking, toxins and viruses, have been indicated to play a role in its pathogenesis. This injury of the endothelium causes an increased migration of leukocytes and lipids into the intima, hereby inducing chronic inflammation, endothelial dysfunction and eventually formation of atherosclerosis. Flow mediated dilatation (FMD) is a known method to measure endothelial dysfunction, and therefore a measure of atherosclerosis. Unfortunately this method has its shortcomings. There is a widespread discussion about its large variability and normal values. Furthermore, the measurements are conducted in the brachial artery, which implies that this artery is a reflection of the vasculature of the whole body. On the other hand, the brachial artery is a vessel in which atherosclerosis never occurs. Therefore, better methods are needed to unravel the many fundamentals of the etiology of the disease. In this area, more research is needed to explain this complicated disease.

Premature atherosclerosis is even a greater challenge. Patients with premature atherosclerosis often display few risk factors, but the clinical manifestations are evident. The question is, if classic risk factors are not the principle cause, what causes this early atherogenesis? The answer may lie in the fact that atherosclerosis is not a monogenic process, but involves both genetics and environmental factors. Possibly premature atherosclerosis may be partly a different disease entity as compared with atherosclerosis in the elderly. This possibility is not taken into account during current treatment of these young individuals.