Endothelial Function Assessment in Cardiovascular Health

The vascular endothelium plays a pivotal role in maintaining cardiovascular homeostasis by modulating vasomotor tone, controlling permeability and regulating thrombosis and inflammation. Endothelial dysfunction is an early event in the pathogenesis of atherosclerosis and often precedes overt clinical disease. Assessment techniques encompass biochemical markers of cellular stress, invasive measures of vascular reactivity and non-invasive tools such as flow-mediated dilation, pulse wave velocity and near-infrared spectroscopy of tissue oxygenation. Recent standardisation efforts have improved reproducibility and enabled large-scale risk stratification. Integrative approaches that combine imaging, haemodynamic profiling and molecular biomarkers are now emerging, offering a holistic evaluation of endothelial health and guiding personalised interventions to mitigate cardiovascular morbidity worldwide.

Research from Nature Portfolio

Recent research in a hypertensive cohort has revealed that higher circulating lactate dehydrogenase levels are associated with reduced flow-mediated dilation, signalling endothelial injury in individuals with elevated blood pressure. Stratified analyses across sex, age and hypertension grade confirmed the inverse LDH–FMD relationship, underscoring LDH’s utility as a biochemical indicator of endothelial compromise. These findings support incorporating enzyme assessment into routine clinical evaluation to enable early detection and targeted management of vascular dysfunction.

Endothelial Function Assessment in Cardiovascular Health publication trend

The graph below shows the total number of articles in endothelial function assessment in cardiovascular health across all publications each year (not limited to Nature Index journals).

Technical terms

Endothelial function: The capacity of the vascular endothelium to regulate blood flow, vascular tone and barrier integrity through the release of signalling molecules, notably nitric oxide.

Endothelial dysfunction: A pathological state characterised by reduced vasodilator production, heightened oxidative stress and pro-inflammatory activity within the endothelium.

Flow-mediated dilation (FMD): A non-invasive ultrasound method for assessing endothelium-dependent vasodilation by measuring arterial diameter changes in response to increased shear stress.

Shear stress: The frictional force exerted by flowing blood on the vessel wall, which stimulates endothelial nitric oxide synthesis and influences vascular tone.

Lactate dehydrogenase (LDH): An intracellular enzyme released during cellular stress or damage, serving as a potential biochemical marker of endothelial injury when elevated in plasma.

References

1. Endogenous estradiol contributes to vascular endothelial dysfunction in premenopausal women with type 1 diabetes. Cardiovascular Diabetology (2023).
2. Noninvasive Assessment of Vascular Function From Physiological Tests to Biomarkers. JACC Asia (2024).
3. Lactate dehydrogenase is associated with flow-mediated dilation in hypertensive patients. Scientific Reports (2023).
4. Repeatability of vascular responsiveness measures derived from near‐infrared spectroscopy. Physiological Reports (2016).
5. Adherence to guidelines strongly improves reproducibility of brachial artery flow-mediated dilation. Atherosclerosis (2016).