L’endothéliopathie : son risque et rôle des facteurs métaboliques

Endothelial dysfunction (ED) has been demonstrated in diabetics, insulin resistant obese patients, patients with hypercholesterolemia or hypertension, and also in smokers. The role played by hyperglycemia, and an excess in free fatty acids and leptin has been evoked. ED may be considered as a vascular integrator of various metabolic disorders and some nutritional factors. Evidence for ED is based on pharmacological tests using acetylcholine in particular, or functional tests like the forearm-mediated vasodilation, but also on the measurement of blood markers or microalbuminuria. ED plays a pathophysiological role in atherothrombosis, tissue ischemia, hypertension and microangiopathic complications of diabetes. ED is an ubiquitous disorder which involves the whole artery network and microcirculation. ED may also contribute to insulin resistance. It may be reversed when improving metabolic disorders and lowering blood pressure. In addition, some oral hypoglycemic agents, lipid or blood pressure lowering drugs are able to improve endothelium function through pleiotropic effects. Various antioxidant agents exert also short-term beneficial effects on the endothelium but their therapeutic effects remain to be defined.