Vascular endothelium: a target organ for diabetes mellitus

Diabetes mellitus is responsible for abnormalities in the control of endothelium-dependent vascular reactivity observed on both coronary arteries and coronary microvessels. These abnormalities of coronary artery circulation are associated with structural microcirculatory abnormalities even in subjects with angiographically normal coronary arteries. Both these structural and functional abnormalities might be responsible for an inadequate coronary response to an increased myocardial metabolic demand, These could be a key factor in the progressive myocardial alterations and in the physiopathology of diabetic cardiomyopathy. Their role in the genesis of arterial hypertension in diabetic patients remain to be clarified. The main physiopathological mechanisms of endothelial dysfunction are reviewed.