Review Article

Vascular endothelial dysfunction, a major mediator in diabetic cardiomyopathy

Authors: Maura Knapp1, Xin Tu1, Rongxue Wu1
1 Department of Medicine, Section of Cardiology, University of Chicago, Chicago, USA
Correspondence to: Rongxue Wu:,
DOI: 10.1038/s41401-018-0042-6
Received: 3 February 2018
Accepted: 6 April 2018
Advance online: 4 June 2018


Diabetes mellitus is currently a major public health problem. A common complication of diabetes is cardiac dysfunction, which is recognized as a microvascular disease that leads to morbidity and mortality in diabetic patients. While ischemic events are commonly observed in diabetic patients, the risk for developing heart failure is also increased, independent of the severity of coronary artery disease and hypertension. This diabetes-associated clinical entity is considered a distinct disease process referred to as “diabetic cardiomyopathy”. However, it is not clear how diabetes promotes cardiac dysfunction. Vascular endothelial dysfunction is thought to be one of the key risk factors. The impact of diabetes on the endothelium involves several alterations, including hyperglycemia, fatty acid oxidation, reduced nitric oxide (NO), oxidative stress, inflammatory activation, and altered barrier function. The current review provides an update on mechanisms that specifically target endothelial dysfunction, which may lead to diabetic cardiomyopathy.
Keywords: cardiomyopathy; diabetes; diabetic cardiovascular complications; endothelium; vascular; heart failure; metabolism

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