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Endothelial dysfunction (ED) is a syndrome characterized by impairment of endothelium dependent vasodilatation,altered anticoagulant, anti-inflammatory and vascular remodeling properties. The dysfunctionalendothelium represents an interim stage between risk factors and atherosclerosis, and is activelyinvolved in the occurrence and development of the majority of cardiovascular diseases. As ED is reversibleand has significant prognostic impacts, there is a growing body of evidence supporting the need forED assessment to become a part of the routine medical practice, however there are still no appropriatemethods available to introduce it. The purpose of this paper is to provide fundamental principles in vascularbiology for clinical cardiologists and to propose some priorities for the future research activities.