*3.2.6. Functional endothelial biomarkers in cardiovascular diseases*

The baseline pathogenic process in cardiovascular diseases, such as atherosclerosis and coronary artery disease, is an endothelial dysfunction with complex underlying mechanisms: oxidative stress, diminished vasoreactivity, hemostatic disturbances, and inflammation leading to the disease progression by modulating the arterial wall, promoting lipoprotein retention, plaque formation and possibly its destabilization. Endothelial dysfunction is characterized by endothelial dysfunction, impaired vascular homeostasis and reduced "anti"-mechanisms (-oxidant, -inflammatory, -thrombotic) and activated "pro"-mechanisms. Diagnostic tools for detecting endothelial dysfunction in humans are limited. They should be safe, cost-effective, noninvasive, repeatable, reproducible, and standardized. Current diagnostic methods are FMD, forearm plethysmography, finger-pulse plethysmography, PWV analysis, and coronary angiography. However, there is a need for additional diagnostic tools, biomarkers. For everyday clinical use, more and larger human-based studies are necessary to validate clinical usefulness of biomarkers [147, 148].
