ABSTRACT
Atherosclerosis first develops in early childhood, with subendothelial accumulation of lipid in the aorta. Macroscopic changes such as fatty streaks and early atherosclerotic lesions have been documented in the coronary arteries of teenagers and young adults (Stary, 1989). The development of such lesions has been related to the presence of vascular risk factors, and in particular the presence of hyperlipidaemia, especially LDL and VLDL subfractions (PDAY investigators, 1990). Recently, investigators have shown that endothelial dysfunction may develop in children with
*Corresponding Author. Department of Cardiology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, 2050, Sydney, Australia
vascular risk factors, before the appearance of macroscopic changes (Celermajer, 1992; Sorensen, 1994). In experimental animals, hypercholesterolaemia perturbs a number of endothelial functions in a dose-dependent and potentially reversible manner. In total, these findings suggest that endothelial dysfunction is a key early event in the development of atherosclerosis and that dyslipidaemias have an important role in the pathogenesis of abnormal endothelial physiology. The possible mechanisms by which atherogenic lipids interfere with normal endothelial function will be discussed in this chapter.
