Vascular Medicine

Based on a number of collaborative efforts between basic researchers and clinicians from different institutions in Leiden, this book covers the initial and promising results of these efforts. The role of the endothelium, especially of the coronary intravascular species is a relatively new and fascinating development in the diagnosis and treatment of cardiac disease. Three major aspects of endothelial function receive attention in this volume: its regulatory role in myocardial function, evidence for which is gradually forthcoming, with possible great implications for disease states such as volume overload and failure its role in the calcium metabolism of vascular smooth muscle cells and the effects of calcium antagonists and the endothelial dysfunction generated by coronary angioplasty and its possible restoration by cholesterol reduction. The topic of imaging atherosclerotic lesions in the coronary arteries is discussed with the emphasis on advanced methods: single photon emission computed tomography (SPECT), positron emission tomography (PET), and magnetic resonance imaging techniques. A wholly new development is the characterization of the atherosclerotic lesion by Raman spectroscopy using a laser beam to illuminate the vascular wall. Various aspects of inflammation related to the pathogenesis of acute coronary syndromes, in particular unstable angina, are illuminated, as well as the role of blood-borne substances as risk factors for atherosclerosis. Transgenic mice carrying the gene for human APOE*3 Leiden are being used successfully to study the environmental and genetic factors that influence the remnant lipoprotein metabolism. Possibilities for gene therapy to treat atherosclerosis in the clinic are being investigated in animal models. Finally, as the book is based on 50 years of Cardiology in Leiden, the history of its development up to the present day is the topic of a separate chapter. This book is intended for cardiologists, internal medicine specialists, nuclear medicine specialists, thoracic surgeons, cardiovascular radiologists and basic scientists in the field of the cardiovascular system.