The Vascular Endothelium in Diabetes

Key Points • The endothelium is a key participant in the homeostasis of the vessel wall. • Nitric oxide (NO) plays a key role in regulating healthy vascular function. • Reduced local NO bioavailability is a characteristic hallmark of vascular endothelial dysfunction. • Endothelial dysfunction is chiefly driven by oxidative stress and inflammation. • A number of techniques for assessing endothelial function are available; flow-mediated dilatation (FMD) is the current noninvasive ‘gold-standard’ methodology. • A number of circulating markers are also helpful in assessment of endothelial dysfunction. • Hyperglycemia, insulin resistance, and dyslipidemia are all important contributors to endothelial dysfunction. • Endothelial dysfunction in diabetes is associated with adverse microand macrovascular complications. • Drug therapies, including statins, insulin sensitizers, and ACE inhibitors, have been shown to improve endothelial dysfunction in diabetes.