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Endothelial dysfunction and type 2 diabetes. Part 1: physiology and methods for exploring the endothelial function
B Guerci1, A Kearney-Schwartz, P Böhme
1Service de Diabétologie, Maladies Métaboliques et Maladies de la Nutrition, Hôpital Jeanne d'Arc, CHU de Nancy, B.P. 303, 54201 Toul Cedex. b.guerci@chu-nancy.fr
Insights
Type 2 diabetes accelerates vascular disease through risk factors like hypertension and dyslipidemia. Improving metabolic control in diabetics can restore normal endothelial function, crucial for vascular health.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Metabolic Disorders
Background:
- Type 2 diabetes mellitus significantly increases morbidity and mortality due to coronary artery, cerebrovascular, and peripheral vascular diseases.
- Accelerated macrovascular complications in type 2 diabetes are linked to cardiovascular risk factors including hypertension, obesity, and dyslipidemia.
- Hyperglycemia-associated factors like advanced glycation end products, oxidized lipoproteins, and reactive oxygen species contribute to macroangiopathy.
Purpose of the Study:
- To explore the role of endothelial dysfunction in the pathogenesis of diabetic angiopathy.
- To investigate the impact of cardiovascular risk factors on endothelial function in type 2 diabetes.
- To assess the potential for metabolic control to restore endothelial function in diabetic patients.
Main Methods:
- Review of literature on type 2 diabetes, macrovascular disease, and endothelial function.
- Analysis of the contribution of cardiovascular risk factors (hypertension, obesity, dyslipidemia) to vascular complications.
- Examination of the relationship between hyperglycemia, advanced glycation, oxidative stress, and endothelial alterations.
- Investigation of insulin resistance as an independent risk factor alongside oxidant stress and prothrombic states.
- Evaluation of endothelial changes in response to improved metabolic control.
Main Results:
- Cardiovascular risk factors significantly impact endothelial function, a key factor in diabetic angiopathy.
- Endothelial dysfunction is implicated in both microangiopathy and macroangiopathy in type 2 diabetes.
- Improved metabolic control, regardless of treatment, is associated with restoration of normal endothelial function.
- Insulin resistance acts as an independent risk factor, exacerbating vascular complications.
Conclusions:
- Endothelial dysfunction is a critical component in the development of vascular complications in type 2 diabetes.
- Addressing cardiovascular risk factors and achieving better metabolic control are essential for preserving endothelial function.
- Restoration of endothelial function through improved metabolic control offers a promising therapeutic avenue for diabetic vascular disease.
Abstract:
Coronary artery, cerebrovascular and peripheral vascular disease, are the principal causes of morbidity and mortality in type 2 diabetes mellitus. The accelerated macrovascular disease in type 2 diabetes mellitus is due partly to the increased incidence of cardiovascular risk factors, such as hypertension, obesity and dyslipidemia. Advanced glycation end products, glycoxidised and oxidized low-density lipoproteins and reactive oxygen species linked to hyperglycemia have all been identified in type 2 diabetes mellitus and could accelerate macroangiopathy. Hence, the resistance to insulin is an additional independent risk factor, in association with oxidant stress, dyslipidemias, and prothrombic/hypofibrinolytic states. The endothelium is a major organ involved by cardiovascular risk factors, such as hypercholesterolemia, hypertension, inflammation, ageing, postmenopausal status, and smoking. Changes in endothelium function may lead to the coronary artery circulation being unable to cope with the increased metabolism of myocardial muscle independently of a reduced coronary artery diameter. The way endothelial function is altered in diabetic patients is not yet fully understood, but the loss of normal endothelial function could be involved in the pathogenesis of diabetic angiopathy, as endothelial dysfunction is associated with diabetic microangiopathy and macroangiopathy. Finally, recent reports indicate that an improved metabolic control in diabetic patients, whatever the treatment used, is associated with near normalization or restoration of normal endothelial function.