Relationship between Natural Activators of Peroxisome Proliferator Activated Receptors (PPARs) and Endothelial Dysfunction in Patients with Peripheral and Coronary Artery Disease

Atherosclerosis is considered as a systemic disease which leads to functional and structural changes in several segments of the arterial system. Morbidity and mortality are mostly caused by Peripheral arterial occlusive disease (PAOD). Vascular endothelium, which is a versatile multifunctional tissue, had synthetic and metabolic properties. Endothelial injury may be responsible, for the initiation of atherosclerosis and vascular lesions which are followed by monocyte infiltration, macrophage differentiation, and migration of smooth muscle cells. von Willebrand factor (vWF), acts as a glycoprotein synthesized mainly by endothelial cells, and is an indicator to endothelial damage. It represents the most sensitive marker of peripheral atherosclerosis. Moreover, intima-media thickness (IMT) increasing is used as a non-invasive of early arterial wall alteration marker and is one method of assessing the development of early atherosclerosis. The Peroxisome proliferator-activated receptors (PPARs) regulate both lipid and lipoprotein metabolism and glucose homeostasis so they influence cellular's proliferation, differentiation and cell apoptotic process. PPAR-alpha activity occurs by leukotriene B4, while, PPAR-gamma activator is the oxidized low-density lipoprotein (ox-LDL). PPAR activation decreases the incidence of cardiovascular disease. Leukotriene B4 (LTB4) causes vascular permeability and attraction and activation of leukocytes. So, Oxidized low-density lipoprotein (ox-LDL) plays a crucial role in the inflammatory process genesis occurring in the atherosclerotic lesion. Increased ox-LDL levels have a direct relation to the acute coronary syndromes severity. The levels of vWF, LTB4 and ox-LDL were measured to find the relationship between these parameters and the severe effects of the disease.