Endothelial Function and Dysfunction

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Abstract
The endothelium is an important locus of control of vascular functions, and reasonable but not perfect methods exist for assessing endothelial function in vivo in humans. Endothelial dysfunction in diabetes complicated by micro‐ or macroalbuminuria is generalized, in that it affects many aspects of endothelial function. The close linkage between microalbuminuria and endothelial dysfunction in diabetes is an attractive explanation for the fact that microalbuminuria is a risk marker for atherothrombosis. In type 1 diabetes, endothelial dysfunction precedes and may cause diabetic microangiopathy, but it is not clear whether endothelial dysfunction is a feature of the diabetic state per se . In type 2 diabetes, endothelial function is impaired from the onset of the disease and is strongly related to adverse outcomes. It is not clear whether impaired endothelial function is caused by hyperglycemia or by other factors. Regardless of the presence of diabetes, impaired endothelial function is closely associated with and may contribute to insulin resistance. Endothelial dysfunction in diabetes originates from three main sources. First, hyperglycemia and its immediate biochemical sequelae directly alter endothelial function. Second, hyperglycemia influences endothelial cell functioning indirectly by the synthesis of growth factors, cytokines, and vasoactive agents in other cells. Third, the components of the metabolic syndrome can impair endothelial function.