Abstract
It is well established that the leading causes of death and disability worldwide are cardiovascular diseases (CVD), chief among which is ischaemic heart disease. However, it is also recognised that ischaemic heart disease frequently coexists with other vascular conditions, such as cerebrovascular, renovascular and peripheral vascular disease, thus raising the notion of a common underlying pathobiology, albeit with differing manifestations, dictated by the implicated vascular bed.The understanding that common metabolic and behavioural risk factors as well as social determinants and drivers are convergent in the development of CVD evokes the idea that the dysfunction of a common bio-molecular platform is central to the occurrence of these diseases. The state of endothelial activation, otherwise known as endothelial dysfunction, occurs when reactive oxygen signalling predominates due to an uncoupled state of endothelial nitric oxide synthase (eNOS). This can be a physiological response to stimulation of the innate immune system or a pathophysiological response triggered by cardiovascular disease risk factors.The conventional wisdom is that the endothelium plays an important role in the initiation, progression and development of CVD and other non-communicable diseases. Consequently, the endothelium has remarkable relevance in clinical and public health practice as well as in health education, health promotion, and disease- and risk-factor prevention strategies. It also presents a plausible unifying hypothesis for the burden of CVD seen globally and in sub-Saharan Africa. Importantly, the heterogeneity in individual responses to metabolic, behavioural, and social drivers of CVD may stem from a complex interplay of these drivers with genomic, epigenetic and environmental factors that underpin eNOS uncoupling. Therefore, further biomedical research into the underlying genetic and other mechanisms of eNOS uncoupling may enlighten and shape strategies for addressing the burden of CVD in sub-Saharan Africa and other regions of the world.
Highlights
It is well established that the leading causes of death and disability worldwide are cardiovascular diseases (CVD), chief among which is ischaemic heart disease
Since moderate levels of physical activity on most days of the week, diets rich in fruit and vegetables and low in saturated and trans fats, and tobacco avoidance have been shown to improve endothelial health and reverse endothelial dysfunction, the adherence to public health strategies for improving physical activity and nutrition are essential for health promotion and the prevention of CVD, which aligns with clinical guidelinerecommended interventions for the treatment and control of the common risk factors associated with CVD
It is important to build on the wealth of scientific information on the endothelium, which has not been tapped by public health practitioners and researchers for translation into policies, programmes and research initiatives for advancing cardiovascular health promotion and the prevention of CVD
Summary
Robert F Furchgott, Louis J Ignarro and Ferid Murad catalysed the wave of research that improved our understanding of endothelial function, which led to the joint award of the 1998 Nobel Prize in Physiology or Medicine ‘for their discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system’. The promotion of endothelial health and reversal of endothelial dysfunction have been associated with increased physical activity, consumption of diets rich in fruit and vegetables, and avoidance of tobacco use or exposure to tobacco smoke.[18,19,20,21,22,23,24] the endothelium has remarkable relevance in clinical and public health practise as well as in health education, health promotion and prevention strategies, and has implications for the epidemiological transition unfolding in developing world regions such as sub-Saharan Africa It suggests that additional research into endothelial function, activation and dysfunction could provide novel proximal targets for clinical, public health and public policy interventions, in an effort to achieve maximum impact on population health
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