Endothelial Dysfunction in South Asian Heart Failure — Worst of Three Ethnic Groups

Key finding

South Asians with heart failure had the worst endothelial function of any ethnic group: - **Microvascular response to acetylcholine**: SA 123% vs White 258% vs African Caribbean 286% (p<0.001) - **FMD**: SA 4.76% vs White 8.49% (p<0.001) - **Endothelium-INDEPENDENT response** (sodium nitroprusside): NORMAL across all groups — smooth muscle works fine, the endothelial lining is specifically broken - **Ethnicity remained associated** with microvascular dysfunction after adjusting for hypertension, diabetes, BP, and glucose

Framework connections: The Missing Mechanics (EPCs), The Immune Priming, The Burn and Crash Model

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