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How to assess endothelial function in (secondary) prevention

Romualdo Belardinelli from the EACPR Cardiac Rehabilitation Section, summarises the most common methods in clinical practice

Patients who suffered cardiovascular events should be referred to a cardiac rehabilitation / secondary prevention program with the objective to improve lifestyle and clinical outcome. (1) Endothelial dysfunction, defined as an abnormal vasomotor response to physical and chemical stimuli which is related to structural and/or functional abnormalities of the endothelium, is present in the majority of them and may not respond to traditional medications. The assessment of endothelial reactivity should be recommended before and after cardiac rehabilitation to determine the degree of endothelial dysfunction, which may be present despite medications, and the response to exercise training and nutrition. From our experience, two/thirds of patients after myocardial revascularization procedures have persistent endothelial dysfunction, and 80% of them improve endothelial function after cardiac rehabilitation. Endothelial dysfunction is an indicator of atherosclerotic artery disease progression and predicts future cardiovascular events. The long-term maintenance of a normal endothelial function after a cardiovascular event is a prerequisite for a better prognosis.

However, there is no consensus on the most appropriate technique for assessing endothelial function. We summarize here the most common methods employed in clinical practice. 



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