Understanding the pathophysiology of the arterial wall: which method should we choose?

Atherosclerosis, the pathological process that underlies myocardial infarction, stroke and other occlusive vascular diseases, is the major cause of death in the Western world. Techniques that accurately and reproducibly detect and measure the early changes that occur in atherosclerosis and/or that identify those who are at highest cardiovascular risk may aid in the development of prevention strategies and may facilitate a decrease in morbidity and mortality from atherosclerosis. Improved understanding of the pathophysiology of early atherosclerosis has allowed development of a number of potential methods for the assessment of early stages in atherosclerosis in humans. These include techniques for assessing early structural changes in the coronary arteries using electron beam computed tomography and magnetic resonance imaging. External vascular ultrasound has also been used to image other circulations as a surrogate marker for coronary atherosclerosis (e.g, measurement of carotid artery, intima-media thickness), Early functional changes in atherosclerosis have also been described many years before the development of structural changes, A number of techniques have been developed to measure endothelial dysfunction (one of the earliest changes in atherosclerosis), including non-invasive measurement of endothelial function using external vascular ultrasound. A variety of serum markers lime also been described, and may be useful markers of atherosclerosis. (C) 2002 The European Society of Cardiology.