Summary
“It is quite useless to argue the questions concerning the development of intimal
scleroses if we study and discuss the late stages of the disease alone. If we wish
to gain insight into the complex question of arterio-sclerosis we must attempt to
follow the lesion from its earliest beginning” (Klotz and Manning, J Path Bact 1911: 16; 211–20).
Over thirty years ago Boneu and colleagues publisheda report of raised levels of plasma
vonWillebrand factor (vWf) in patients with arteritis, diabetes and sepsis. They concluded
that raised levels of this molecule indicate endothelial damage, and may possibly
be a contributory factor in thrombosis in arterial disease. The former aspect of this
conclusion is now accepted, and numerous studies on the risk factors for atherosclerosis
provide mechanisms for this damage. Other studies have demonstrated raised levels
in cancer and in connective tissue disease. Numerous long-term follow-up studies have
also demonstrated that increased vWf predicts major cardiovascular end points. However,
the link between these studies, and the latter aspect of Boneu’s conclusion, that
raised vWf contributes to thrombosis is,although attractive, nevertheless unproven.
Despite this, vWf remains the most important plasma marker of endothelial damage/dysfunction
and as such attracts clinical attention.
Keywords
Endothelium - vonWillebrand factor - thrombosis - atherosclerosis