Kabutoya T. Arterial stiffness and endothelial dysfunction in diabetes mellitus. World J Transl Med 2026; 12(3): 123615 [DOI: 10.5528/wjtm.123615]
Corresponding Author of This Article
Tomoyuki Kabutoya, Associate Professor, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke 3290498, Tochigi, Japan. kabu@jichi.ac.jp
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transl Med. Sep 28, 2026; 12(3): 123615 Published online Sep 28, 2026. doi: 10.5528/wjtm.123615
Arterial stiffness and endothelial dysfunction in diabetes mellitus
Tomoyuki Kabutoya
Tomoyuki Kabutoya, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke 3290498, Tochigi, Japan
Author contributions: Kabutoya T conceived the idea for the review, conducted the literature search, analyzed the relevant publications, wrote the manuscript, and reviewed and approved the final version of the manuscript.
AI contribution statement: AI tools (ChatGPT) were used solely to assist in the initial conceptual development and organization of the framework presented in Figure 1. No AI tool was used for study design, literature selection, interpretation of evidence, formulation of conclusions, or reference preparation. The final figure was independently created, edited, and validated by the authors using Microsoft PowerPoint. During the preparation of the revised manuscript and the response to reviewers, ChatGPT (Copilot) was used solely to assist with improving language, readability, and grammar.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Tomoyuki Kabutoya, Associate Professor, Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke 3290498, Tochigi, Japan. kabu@jichi.ac.jp
Received: May 26, 2026 Revised: July 18, 2026 Accepted: July 28, 2026 Published online: September 28, 2026 Processing time: 102 Days and 20.5 Hours
Abstract
In diabetes mellitus, arterial stiffness and endothelial dysfunction develop from an early stage, and their combined progression increases the risk of cardiovascular disease. In recent years, noninvasive measures of vascular function - such as pulse wave velocity, the cardio-ankle vascular index, flow-mediated dilation (FMD), and reactive hyperemia-peripheral arterial tonometry (RH-PAT) - have attracted attention as tools for assessing subclinical vascular damage in diabetes. Pulse wave velocity is regarded as the gold standard for evaluating arterial stiffness and is supported by extensive evidence, while cardio-ankle vascular index, which is less dependent on blood pressure, has demonstrated predictive value for cardiovascular events, mainly in prospective studies. In contrast, FMD and RH-PAT primarily reflect endothelial function: FMD assesses nitric oxide-dependent endothelial function in large conduit arteries, whereas RH-PAT evaluates endothelial reactivity at the level of the microvasculature, thereby capturing different aspects of vascular physiology. These indices are not interchangeable; rather, they complement one another by reflecting distinct facets of vascular pathology in diabetes. An integrated assessment of both arterial stiffness and endothelial function may therefore enable cardiovascular risk stratification beyond traditional risk factors.
Core Tip: Diabetes mellitus accelerates vascular aging through the concurrent progression of arterial stiffness and endothelial dysfunction, both of which independently contribute to cardiovascular risk. Noninvasive vascular indices - including pulse wave velocity, the cardio-ankle vascular index, flow-mediated dilation, and reactive hyperemia-peripheral arterial tonometry - capture distinct but complementary aspects of diabetic vascular pathology. These measures are not interchangeable; rather, their integrated assessment may enhance early detection of subclinical vascular damage and improve cardiovascular risk stratification beyond traditional risk factors in patients with diabetes.
