Koronare Herzkrankheit: konservative statt invasive

Summary Coronary heart disease: conservative instead of invasive therapy? Endothelial dysfunction: myth or reality? In patients with stable coronary artery disease (CAD) percutaneous coronary interventions (PCI) have the potential to improve symptoms. Obviously, PCI increases locally the coronary artery lumen area, but does not affect the ath- erosclerotic process per se located generalised within the arterial wall of the arterial tree. Accordingly, the evidence that PCI improves outcome in these patients is limited. In con- trast, several conservative therapeutic inter- ventions that improve the impaired endo- thelial function in patients with CAD - such as physical training, ACE-inhibitors/ARBs and statins - have been shown to improve both, symptoms and prognosis in patients with sta- ble CAD. Endothelial function as a target of conservative therapies as mentioned above is therefore not a myth but a therapeutic chance and reality not to be underscored in the thera- py of patients with CAD. Furthermore, the ex- isting evidence supports the concept that im- provement of endothelial function (ie improve- ment of the health of the vascular wall) as achieved by physical training, ACE-in- hibitors/ARBs and statins can be translated in- to improved outcome in patients with CAD. En- dothelial function represents therefore one of the decisive targets that make conservative therapy successful by affecting the atheroscle- rotic process per se.