Diabetes mellitus-associated vascular impairment: novel circulating biomarkers and therapeutic approaches

J Am Coll Cardiol. 2013 Aug 20;62(8):667-76. doi: 10.1016/j.jacc.2013.03.089.


It is widely accepted that diabetes mellitus (DM) impairs endothelial nitric oxide synthase activity as well as enhances the production of reactive oxygen species, thus resulting in diminished nitric oxide bioavailability and the consequent pro-atherogenetic alterations. Important biomarkers of the vasculature are related to endothelial dysfunction, to inflammatory and coagulation processes, and to oxidative stress in DM. Several therapeutic strategies might exert favorable effects on the vasculature of diabetic patients, such as insulin analogues, antihypertensive agents, statins, and hypoglycemic agents, whereas in spite of the prominent role of oxidative stress in diabetes, antioxidant therapy remains controversial. The use of specific biomarkers related to vascular function could be a useful therapeutic approach in such patients.

Keywords: ADMA; BH4; C-reactive protein; CAD; CRP; DM; EMP; EPC; FFAs; FMD; ICAM; IL; LPS; MET; MP; NO; PAI; ROS; T2D; TNF; VCAM; asymmetric dimethylarginine; biomarkers; coronary artery disease; diabetes mellitus; eNOS; endothelial microparticle; endothelial nitric oxide synthase; endothelial progenitor cell; endothelium; flow-mediated dilation; free-fatty acids; high-sensitivity C-reactive protein; hsCRP; intercellular adhesion molecule; interleukin; lipopolysaccharide; metformin; miR; micro-ribonucleic acid; microparticle; nitric oxide; oxLDL; oxidized low-density lipoprotein; plasminogen activator inhibitor; reactive oxygen species; tetrahydrobiopterin; tumor necrosis factor; type 2 diabetes mellitus; vWF; vascular cell adhesion molecule; vascular function; von Willebrand factor.

Publication types

  • Review

MeSH terms

  • Antioxidants / therapeutic use
  • Biomarkers / blood*
  • C-Reactive Protein / analysis
  • Cytokines / blood
  • Diabetic Angiopathies / blood*
  • Diabetic Angiopathies / physiopathology*
  • Endothelium, Vascular / drug effects
  • Endothelium, Vascular / physiopathology
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / pharmacology
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hyperglycemia / physiopathology
  • Insulin Resistance / physiology
  • Oxidative Stress / drug effects
  • Oxidative Stress / physiology
  • RNA, Messenger / physiology
  • Tumor Necrosis Factor-alpha / physiology


  • Antioxidants
  • Biomarkers
  • Cytokines
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • RNA, Messenger
  • Tumor Necrosis Factor-alpha
  • C-Reactive Protein