Vascular Endothelial Dysfunction: Complication of Diabetes Mellitus and Hyperhomocysteinemia

Vascular endothelium is the innermost monolayer of blood vessels. It controls vascular tone, hemostasis, endothelial permeability, vascular growth and interaction between endothelium and leukocytes. Endothelial nitric oxide syntheses (eNOS), an enzyme responsible for synthesis of nitric oxide. Vascular endothelial dysfunction (VED) is the imbalance between vasorelaxation and vasoconstriction, thrombosis and thrombolysis, growth promotion and growth inhibition. Vascular endothelial dysfunction is implicated in essential hypertension, congestive heart failure, diabetes mellitus, hyperhomocysteinemia, erectile dysfunction and secondary complications of atherosclerosis. Diabetes mellitus and hyperhomocysteinemia induces vascular endothelial dysfunction by various mechanisms. NO is responsible for various physiologic and pathophysiologic changes in vascular endothelium. Oxidative stress plays an important role in VED. Various pathological pathways and pharmacological interventions have been discussed in the present review for understanding of vascular endothelial dysfunction. New drugs which improve diabetes mellitus, hyperhomocysteinemia and other implications of VED, will be the novel future approach for management of VED and its complications.