Published online Oct 15, 2014. doi: 10.4239/wjd.v5.i5.601
Revised: June 30, 2014
Accepted: July 18, 2014
Published online: October 15, 2014
Patients with diabetes mellitus are at high risk of developing atherosclerosis, associated with higher rates of micro and macro vascular involvement such as coronary artery disease and renal disease. The role of hyperglycemia to induce synthesis of reactive oxygen species by the oxidation of glucose, leading to an increased production of advanced glycosylation end products, as well as inflammation and oxidative stress has been proposed as a possible mechanism in the pathogenesis of endothelial dysfunction (ED). The interaction between C-peptide - the connecting segment of pro-insulin-and nitric oxide in vasodilation is also discussed. Therefore, endothelial dysfunction has been identified as an early marker of vascular disorder in type 1 and type 2 diabetes mellitus. In some other diseases, ED has been considered an independent predictor of vascular disease, regardless of the method used. Studies have demonstrated the importance of endothelial dysfunction as an useful tool for identifying the risk of vascular complications in patients with type 1 diabetes mellitus, particularly as regards to renal impairment. The aim of this review is to clarify the prognostic value of endothelial dysfunction as a marker of vascular disease in these subjects.
Core tip: This review is divided into two parts: first we discuss aspects related to the pathogenesis of endothelial dysfunction in type 1 diabetes mellitus. In the second, are pointed out and critically discussed the scientific evidence about the important role of endothelial dysfunction, independent of the method used for its diagnosis, as an early marker of cardiovascular and renal complications in this population.