This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kawano, H. Articles by Yasue, H. Search for Related Content PubMed PubMed Citation Articles by Kawano, H. Articles by Yasue, H.

CLINICAL STUDIES

Hyperglycemia rapidly suppresses flow-mediated endothelium- dependent vasodilation of brachial artery

^a Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan

Manuscript received November 9, 1998; revised manuscript received February 19, 1999, accepted March 24, 1999.

Reprint requests and correspondence: Dr. Hirofumi Yasue, Department of Cardiovascular Medicine, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto City 860-8556, Japan
yasue{at}gpo.kumamoto-u.ac.jp

OBJECTIVES

We examined whether endothelial dysfunction occurs when acute hyperglycemia is induced by oral glucose loading.

BACKGROUND

Endothelial dysfunction has been shown to occur in patients with diabetes mellitus (DM), and chronic hyperglycemia is implicated as a cause of endothelial dysfunction. However, in many patients with Type 2 DM and in those with impaired glucose tolerance (IGT), fasting blood glucose may be within normal limits, and hyperglycemia occurred only post-prandially.

METHODS

With ultrasound technique, we measured flow-mediated endothelium-dependent vasodilation during oral glucose tolerance test in 58 subjects: (17 patients with normal glucose tolerance [NGT], 24 with IGT, and 17 with type 2 DM). In addition, we measured the levels of thiobarbituric acid reactive substances (TBARS) and nitrite/nitrate.

RESULTS

Flow-mediated vasodilation decreased after glucose loading (NGT: 7.53 ± 0.40, 4.24 ± 0.28 and 6.35 ± 0.40, in fasting, at 1- and 2-h, respectively, IGT: 6.50 ± 0.48, 1.40 ± 0.41** and 4.00 ± 0.47*, respectively; DM: 4.77 ± 0.37, 1.35 ± 0.38** and 1.29 ± 0.29%**, respectively; *p < 0.01 vs. fasting, **p < 0.005 vs. fasting). The TBARS concentration increased in parallel with plasma glucose level in each group (NGT: 1.43 ± 0.07, 2.03 ± 0.12 and 1.80 ± 0.12, respectively; IGT: 1.65 ± 0.11, 2.46 ± 0.12** and 1.94 ± 0.08*, respectively; DM: 1.73 ± 0.07, 2.34 ± 0.08** and 2.47 ± 0.09** nmol/ml, respectively; *p < 0.05 vs. fasting, **p < 0.01 vs. fasting). Glucose loading did not change nitrite/nitrate concentration in any of the groups.

CONCLUSIONS

Hyperglycemia in response to oral glucose loading rapidly suppresses endothelium-dependent vasodilation, probably through increased production of oxygen-derived free radicals. These findings strongly suggest that prolonged and repeated post-prandial hyperglycemia may play an important role in the development and progression of atherosclerosis.

Abbreviations and Acronyms   ANOVA = analysis of variance   DM = diabetes mellitus   FMD = flow-mediated dilation   HDL = high-density lipoprotein   IGT = impaired glucose tolerance   LDL = low-density lipoprotein   NGT = normal glucose tolerance   NO = nitric oxide   OGTT = oral glucose tolerance test   TBARS = thiobarbituric acid reactive substances

This article has been cited by other articles:

				M. Hanefeld, S. R. Bornstein, and F. Pistrosch Shifting the Disease Management Paradigm From Glucose: What are the cons? Diabetes Care, November 1, 2009; 32(suppl_2): S353 - S356. [Full Text] [PDF]

				A. Soylu, K. Ozdemir, M. A. Duzenli, M. Yazici, and M. Tokac Impact on Diabetes Mellitus on the Epicardial Coronary Flow Velocity Assessed by the Thrombolysis in Myocardial Infarction Frame Count Angiology, August 1, 2009; 60(4): 431 - 440. [Abstract] [PDF]

				T. Lavi, A. Karasik, N. Koren-Morag, H. Kanety, M. S. Feinberg, and M. Shechter The acute effect of various glycemic index dietary carbohydrates on endothelial function in nondiabetic overweight and obese subjects. J. Am. Coll. Cardiol., June 16, 2009; 53(24): 2283 - 2287. [Abstract] [Full Text] [PDF]

				M. Kosiborod, S. E. Inzucchi, J. A. Spertus, Y. Wang, F. A. Masoudi, E. P. Havranek, and H. M. Krumholz Elevated Admission Glucose and Mortality in Elderly Patients Hospitalized With Heart Failure Circulation, April 14, 2009; 119(14): 1899 - 1907. [Abstract] [Full Text] [PDF]

				Z. Yang, V. E. Laubach, B. A. French, and I. L. Kron Acute hyperglycemia enhances oxidative stress and exacerbates myocardial infarction by activating nicotinamide adenine dinucleotide phosphate oxidase during reperfusion. J. Thorac. Cardiovasc. Surg., March 1, 2009; 137(3): 723 - 729. [Abstract] [Full Text] [PDF]

				N. Bjarnegard, H. J Arnqvist, T.;r. Lindstro;m, L. Jonasson, and T. Lanne Long-term hyperglycaemia impairs vascular smooth muscle cell function in women with type 1 diabetes mellitus Diabetes and Vascular Disease Research, January 1, 2009; 6(1): 25 - 31. [Abstract] [PDF]

				A. Ceriello Cardiovascular effects of acute hyperglycaemia: pathophysiological underpinnings Diabetes and Vascular Disease Research, November 1, 2008; 5(4): 260 - 268. [Abstract] [PDF]

				E. P Weiss, H. Arif, D. T Villareal, E. Marzetti, and J. O Holloszy Endothelial function after high-sugar-food ingestion improves with endurance exercise performed on the previous day Am. J. Clinical Nutrition, July 1, 2008; 88(1): 51 - 57. [Abstract] [Full Text] [PDF]

				S. Dickinson, D. P Hancock, P. Petocz, A. Ceriello, and J. Brand-Miller High-glycemic index carbohydrate increases nuclear factor-{kappa}B activation in mononuclear cells of young, lean healthy subjects Am. J. Clinical Nutrition, May 1, 2008; 87(5): 1188 - 1193. [Abstract] [Full Text] [PDF]

				A. Ceriello, K. Esposito, L. Piconi, M. A. Ihnat, J. E. Thorpe, R. Testa, M. Boemi, and D. Giugliano Oscillating Glucose Is More Deleterious to Endothelial Function and Oxidative Stress Than Mean Glucose in Normal and Type 2 Diabetic Patients Diabetes, May 1, 2008; 57(5): 1349 - 1354. [Abstract] [Full Text] [PDF]

				K. Esposito, M. Ciotola, D. Carleo, B. Schisano, L. Sardelli, D. Di Tommaso, L. Misso, F. Saccomanno, A. Ceriello, and D. Giugliano Post-Meal Glucose Peaks at Home Associate with Carotid Intima-Media Thickness in Type 2 Diabetes J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1345 - 1350. [Abstract] [Full Text] [PDF]

				L. A. Lesniewski, A. J. Donato, B. J. Behnke, C. R. Woodman, M. H. Laughlin, C. A. Ray, and M. D. Delp Decreased NO signaling leads to enhanced vasoconstrictor responsiveness in skeletal muscle arterioles of the ZDF rat prior to overt diabetes and hypertension Am J Physiol Heart Circ Physiol, April 1, 2008; 294(4): H1840 - H1850. [Abstract] [Full Text] [PDF]

				P. Deedwania, M. Kosiborod, E. Barrett, A. Ceriello, W. Isley, T. Mazzone, and P. Raskin Hyperglycemia and Acute Coronary Syndrome: A Scientific Statement From the American Heart Association Diabetes Committee of the Council on Nutrition, Physical Activity, and Metabolism Circulation, March 25, 2008; 117(12): 1610 - 1619. [Abstract] [Full Text] [PDF]

				J.-e. Obata and K. Kugiyama Reply. J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1125 - 1125. [Full Text] [PDF]

				R. W. Nesto and R. M. Lago Glucose: A Biomarker in Acute Myocardial Infarction Ready for Prime Time? Circulation, February 26, 2008; 117(8): 990 - 992. [Full Text] [PDF]

				M. Kosiborod, S. E. Inzucchi, H. M. Krumholz, L. Xiao, P. G. Jones, S. Fiske, F. A. Masoudi, S. P. Marso, and J. A. Spertus Glucometrics in Patients Hospitalized With Acute Myocardial Infarction: Defining the Optimal Outcomes-Based Measure of Risk Circulation, February 26, 2008; 117(8): 1018 - 1027. [Abstract] [Full Text] [PDF]

				R. Peter and A. Rees Review: Postprandial glycaemia and cardiovascular risk The British Journal of Diabetes & Vascular Disease, January 1, 2008; 8(1): 8 - 14. [Abstract] [PDF]

				R. P. Naoumova, H. Kindler, L. Leccisotti, M. Mongillo, M. T. Khan, C. Neuwirth, M. Seed, P. Holvoet, J. Betteridge, and P. G. Camici Pioglitazone Improves Myocardial Blood Flow and Glucose Utilization in Nondiabetic Patients With Combined Hyperlipidemia: A Randomized, Double-Blind, Placebo-Controlled Study J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2051 - 2058. [Abstract] [Full Text] [PDF]

				T. Mita, H. Watada, T. Shimizu, Y. Tamura, F. Sato, T. Watanabe, J. B. Choi, T. Hirose, Y. Tanaka, and R. Kawamori Nateglinide Reduces Carotid Intima-Media Thickening in Type 2 Diabetic Patients Under Good Glycemic Control Arterioscler Thromb Vasc Biol, November 1, 2007; 27(11): 2456 - 2462. [Abstract] [Full Text] [PDF]

				E. Toth, A. Racz, J. Toth, P. M. Kaminski, M. S. Wolin, Z. Bagi, and A. Koller Contribution of polyol pathway to arteriolar dysfunction in hyperglycemia. Role of oxidative stress, reduced NO, and enhanced PGH2/TXA2 mediation Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H3096 - H3104. [Abstract] [Full Text] [PDF]

				J. Uribarri, A. Stirban, D. Sander, W. Cai, M. Negrean, C. E. Buenting, T. Koschinsky, and H. Vlassara Single Oral Challenge by Advanced Glycation End Products Acutely Impairs Endothelial Function in Diabetic and Nondiabetic Subjects Diabetes Care, October 1, 2007; 30(10): 2579 - 2582. [Abstract] [Full Text] [PDF]

				H. Zheng, M. Patel, R. Cable, L. Young, and S. D. Katz Insulin Sensitivity, Vascular Function, and Iron Stores in Voluntary Blood Donors Diabetes Care, October 1, 2007; 30(10): 2685 - 2689. [Abstract] [Full Text] [PDF]

				C. Junor and K. C. Dellsperger Can we use surrogate vascular beds for evaluating endothelial function of the coronary vasculature in patients with cardiac allografts? Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H13 - H14. [Full Text] [PDF]

				P. H. McNulty, M. A. Tulli, B. J. Robertson, V. Lendel, L. A. Harach, S. Scott, and J. P. Boehmer Effect of simulated postprandial hyperglycemia on coronary blood flow in cardiac transplant recipients Am J Physiol Heart Circ Physiol, July 1, 2007; 293(1): H103 - H108. [Abstract] [Full Text] [PDF]

				S. J Hamilton, G. T Chew, and G. F Watts Therapeutic regulation of endothelial dysfunction in type 2 diabetes mellitus Diabetes and Vascular Disease Research, June 1, 2007; 4(2): 89 - 102. [Abstract] [PDF]

				S. W. Zarich and R. W. Nesto Implications and Treatment of Acute Hyperglycemia in the Setting of Acute Myocardial Infarction Circulation, May 8, 2007; 115(18): e436 - e439. [Full Text] [PDF]

				J. A. Beckman, A. B. Goldfine, A. Dunaif, M. Gerhard-Herman, and M. A. Creager Endothelial Function Varies According to Insulin Resistance Disease Type Diabetes Care, May 1, 2007; 30(5): 1226 - 1232. [Abstract] [Full Text] [PDF]

				M. E. J. Lott, C. Hogeman, M. Herr, R. Gabbay, and L. I. Sinoway Effects of an oral glucose tolerance test on the myogenic response in healthy individuals Am J Physiol Heart Circ Physiol, January 1, 2007; 292(1): H304 - H310. [Abstract] [Full Text] [PDF]

				P. N Bavenholm and S. Efendic Postprandial hyperglycaemia and vascular damage - the benefits of acarbose Diabetes and Vascular Disease Research, September 1, 2006; 3(2): 72 - 79. [Abstract] [PDF]

				S. Yasuda, S. Miyazaki, M. Kanda, Y. Goto, M. Suzuki, Y. Harano, and H. Nonogi Intensive treatment of risk factors in patients with type-2 diabetes mellitus is associated with improvement of endothelial function coupled with a reduction in the levels of plasma asymmetric dimethylarginine and endogenous inhibitor of nitric oxide synthase Eur. Heart J., May 2, 2006; 27(10): 1159 - 1165. [Abstract] [Full Text] [PDF]

				M. Shimabukuro, N. Higa, I. Chinen, K. Yamakawa, and N. Takasu Effects of a Single Administration of Acarbose on Postprandial Glucose Excursion and Endothelial Dysfunction in Type 2 Diabetic Patients: A Randomized Crossover Study J. Clin. Endocrinol. Metab., March 1, 2006; 91(3): 837 - 842. [Abstract] [Full Text] [PDF]

				J. S. Naik, L. Xiang, and R. L. Hester Enhanced role for RhoA-associated kinase in adrenergic-mediated vasoconstriction in gracilis arteries from obese Zucker rats Am J Physiol Regulatory Integrative Comp Physiol, January 1, 2006; 290(1): R154 - R161. [Abstract] [Full Text] [PDF]

				R. Scognamiglio, C. Negut, S. V. De Kreutzenberg, A. Tiengo, and A. Avogaro Postprandial Myocardial Perfusion in Healthy Subjects and in Type 2 Diabetic Patients Circulation, July 12, 2005; 112(2): 179 - 184. [Abstract] [Full Text] [PDF]

				E. D. Beishuizen, J. T. Tamsma, J. W. Jukema, M. A. van de Ree, J. C. M. van der Vijver, A. E. Meinders, and M. V. Huisman The Effect of Statin Therapy on Endothelial Function in Type 2 Diabetes Without Manifest Cardiovascular Disease Diabetes Care, July 1, 2005; 28(7): 1668 - 1674. [Abstract] [Full Text] [PDF]

				B. Capaldo, M. Galderisi, A. A. Turco, A. D'Errico, S. Turco, A. A. Rivellese, G. de Simone, O. de Divitiis, and G. Riccardi Acute Hyperglycemia Does Not Affect the Reactivity of Coronary Microcirculation in Humans J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 3871 - 3876. [Abstract] [Full Text] [PDF]

				A. Ceriello, R. Assaloni, R. Da Ros, A. Maier, L. Piconi, L. Quagliaro, K. Esposito, and D. Giugliano Effect of Atorvastatin and Irbesartan, Alone and in Combination, on Postprandial Endothelial Dysfunction, Oxidative Stress, and Inflammation in Type 2 Diabetic Patients Circulation, May 17, 2005; 111(19): 2518 - 2524. [Abstract] [Full Text] [PDF]

				G. T. McMahon, J. Plutzky, E. Daher, T. Bhattacharyya, G. Grunberger, and M. F. DiCarli Effect of a Peroxisome Proliferator-Activated Receptor-{gamma} Agonist on Myocardial Blood Flow in Type 2 Diabetes Diabetes Care, May 1, 2005; 28(5): 1145 - 1150. [Abstract] [Full Text] [PDF]

				M. L. Bots, J. Westerink, T. J. Rabelink, and E. J.P. de Koning Assessment of flow-mediated vasodilatation (FMD) of the brachial artery: effects of technical aspects of the FMD measurement on the FMD response Eur. Heart J., February 2, 2005; 26(4): 363 - 368. [Abstract] [Full Text] [PDF]

				P. A. Kaufmann and P. G. Camici Myocardial Blood Flow Measurement by PET: Technical Aspects and Clinical Applications J. Nucl. Med., January 1, 2005; 46(1): 75 - 88. [Full Text] [PDF]

				A. Ceriello Postprandial Hyperglycemia and Diabetes Complications: Is It Time to Treat? Diabetes, January 1, 2005; 54(1): 1 - 7. [Abstract] [Full Text] [PDF]

				M E Tushuizen, M Diamant, and R J Heine Postprandial dysmetabolism and cardiovascular disease in type 2 diabetes Postgrad. Med. J., January 1, 2005; 81(951): 1 - 6. [Abstract] [Full Text] [PDF]

				B. A. Mullan, C. N. Ennis, H. J. P. Fee, I. S. Young, and D. R. McCance Protective effects of ascorbic acid on arterial hemodynamics during acute hyperglycemia Am J Physiol Heart Circ Physiol, September 1, 2004; 287(3): H1262 - H1268. [Abstract] [Full Text] [PDF]

				Z. Bagi, E. Toth, A. Koller, and G. Kaley Microvascular dysfunction after transient high glucose is caused by superoxide-dependent reduction in the bioavailability of NO and BH4 Am J Physiol Heart Circ Physiol, August 1, 2004; 287(2): H626 - H633. [Abstract] [Full Text] [PDF]

				F. M. Maggi, S. Raselli, L. Grigore, L. Redaelli, S. Fantappie, and A. L. Catapano Lipoprotein Remnants and Endothelial Dysfunction in the Postprandial Phase J. Clin. Endocrinol. Metab., June 1, 2004; 89(6): 2946 - 2950. [Abstract] [Full Text] [PDF]

				M. E. Otto, A. Svatikova, R. B. d. M. Barretto, S. Santos, M. Hoffmann, B. Khandheria, and V. Somers Early Morning Attenuation of Endothelial Function in Healthy Humans Circulation, June 1, 2004; 109(21): 2507 - 2510. [Abstract] [Full Text] [PDF]

				I. Stranders, M. Diamant, R. E. van Gelder, H. J. Spruijt, J. W. R. Twisk, R. J. Heine, and F. C. Visser Admission Blood Glucose Level as Risk Indicator of Death After Myocardial Infarction in Patients With and Without Diabetes Mellitus Arch Intern Med, May 10, 2004; 164(9): 982 - 988. [Abstract] [Full Text] [PDF]

				A. Ceriello and E. Motz Is Oxidative Stress the Pathogenic Mechanism Underlying Insulin Resistance, Diabetes, and Cardiovascular Disease? The Common Soil Hypothesis Revisited Arterioscler Thromb Vasc Biol, May 1, 2004; 24(5): 816 - 823. [Abstract] [Full Text]

				M. Hanefeld, J. L. Chiasson, C. Koehler, E. Henkel, F. Schaper, and T. Temelkova-Kurktschiev Acarbose Slows Progression of Intima-Media Thickness of the Carotid Arteries in Subjects With Impaired Glucose Tolerance Stroke, May 1, 2004; 35(5): 1073 - 1078. [Abstract] [Full Text] [PDF]

				G. N. Thomas, P. Chook, M. Qiao, X. S. Huang, H. C. Leong, D. S. Celermajer, and K. S. Woo Deleterious Impact of "High Normal" Glucose Levels and Other Metabolic Syndrome Components on Arterial Endothelial Function and Intima-Media Thickness in Apparently Healthy Chinese Subjects: The CATHAY Study Arterioscler Thromb Vasc Biol, April 1, 2004; 24(4): 739 - 743. [Abstract] [Full Text] [PDF]

				S. Clement, S. S. Braithwaite, M. F. Magee, A. Ahmann, E. P. Smith, R. G. Schafer, and I. B. Hirsch Management of Diabetes and Hyperglycemia in Hospitals Diabetes Care, February 1, 2004; 27(2): 553 - 591. [Full Text] [PDF]

				M. Raitakari, T. Ilvonen, M. Ahotupa, T. Lehtimaki, A. Harmoinen, P. Suominen, J. Elo, J. Hartiala, and O. T. Raitakari Weight Reduction With Very-Low-Caloric Diet and Endothelial Function in Overweight Adults: Role of Plasma Glucose Arterioscler Thromb Vasc Biol, January 1, 2004; 24(1): 124 - 128. [Abstract] [Full Text] [PDF]

				J. R. Singleton, A. G. Smith, J. W. Russell, and E. L. Feldman Microvascular Complications of Impaired Glucose Tolerance Diabetes, December 1, 2003; 52(12): 2867 - 2873. [Abstract] [Full Text] [PDF]

				J.-L. Chiasson, R. G. Josse, R. Gomis, M. Hanefeld, A. Karasik, and M. Laakso Acarbose Treatment and the Risk of Cardiovascular Disease and Hypertension in Patients With Impaired Glucose Tolerance: The STOP-NIDDM Trial JAMA, July 23, 2003; 290(4): 486 - 494. [Abstract] [Full Text] [PDF]

				N. Ihlemann, C. Rask-Madsen, A. Perner, H. Dominguez, T. Hermann, L. Kober, and C. Torp-Pedersen Tetrahydrobiopterin restores endothelial dysfunction induced by an oral glucose challenge in healthy subjects Am J Physiol Heart Circ Physiol, July 11, 2003; 285(2): H875 - H882. [Abstract] [Full Text] [PDF]

				Z. T. Bloomgarden Inflammation and Insulin Resistance Diabetes Care, June 1, 2003; 26(6): 1922 - 1926. [Full Text] [PDF]

				A. Ceriello New Insights on Oxidative Stress and Diabetic Complications May Lead to a "Causal" Antioxidant Therapy Diabetes Care, May 1, 2003; 26(5): 1589 - 1596. [Abstract] [Full Text] [PDF]

				M. F. Di Carli, J. Janisse, G. Grunberger, and J. Ager Role of chronic hyperglycemia in the pathogenesis of coronary microvascular dysfunction in diabetes J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1387 - 1393. [Abstract] [Full Text] [PDF]

				B. A. Kingwell, M. Formosa, M. Muhlmann, S. J. Bradley, and G. K. McConell Type 2 Diabetic Individuals Have Impaired Leg Blood Flow Responses to Exercise: Role of endothelium-dependent vasodilation Diabetes Care, March 1, 2003; 26(3): 899 - 904. [Abstract] [Full Text] [PDF]

				S. Schiekofer, M. Andrassy, J. Chen, G. Rudofsky, J. Schneider, T. Wendt, N. Stefan, P. Humpert, A. Fritsche, M. Stumvoll, et al. Acute Hyperglycemia Causes Intracellular Formation of CML and Activation of ras, p42/44 MAPK, and Nuclear Factor {kappa}B in PBMCs Diabetes, March 1, 2003; 52(3): 621 - 633. [Abstract] [Full Text] [PDF]

				S.-i. Koide, K. Kugiyama, S. Sugiyama, S.-i. Nakamura, H. Fukushima, O. Honda, M. Yoshimura, and H. Ogawa Association of polymorphism in glutamate-cysteine ligase catalytic subunit gene with coronary vasomotor dysfunction and myocardial infarction J. Am. Coll. Cardiol., February 19, 2003; 41(4): 539 - 545. [Abstract] [Full Text] [PDF]

				R. J Woodman, T. A Mori, V. Burke, I. B Puddey, G. F Watts, and L. J Beilin Effects of purified eicosapentaenoic and docosahexaenoic acids on glycemic control, blood pressure, and serum lipids in type 2 diabetic patients with treated hypertension Am. J. Clinical Nutrition, November 1, 2002; 76(5): 1007 - 1015. [Abstract] [Full Text] [PDF]

				A. Ceriello, C. Taboga, L. Tonutti, L. Quagliaro, L. Piconi, B. Bais, R. Da Ros, and E. Motz Evidence for an Independent and Cumulative Effect of Postprandial Hypertriglyceridemia and Hyperglycemia on Endothelial Dysfunction and Oxidative Stress Generation: Effects of Short- and Long-Term Simvastatin Treatment Circulation, September 3, 2002; 106(10): 1211 - 1218. [Abstract] [Full Text] [PDF]

				Z. T. Bloomgarden European Association for the Study of Diabetes (EASD) 2001 Meeting Diabetes Care, July 1, 2002; 25(7): 1229 - 1236. [Full Text] [PDF]

				G. Paradisi, A. Biaggi, S. Ferrazzani, S. De Carolis, and A. Caruso Abnormal Carbohydrate Metabolism During Pregnancy : Association with endothelial dysfunction Diabetes Care, March 1, 2002; 25(3): 560 - 564. [Abstract] [Full Text] [PDF]

				M. Kelm Flow-mediated dilatation in human circulation: diagnostic and therapeutic aspects Am J Physiol Heart Circ Physiol, January 1, 2002; 282(1): H1 - H5. [Full Text] [PDF]

				K. K. Koh, M. H. Kang, D. K. Jin, S.-K. Lee, J. Y. Ahn, H. Y. Hwang, S. H. Yang, D. S. Kim, T. H. Ahn, and E. K. Shin Vascular effects of estrogen in type II diabetic postmenopausal women J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1409 - 1415. [Abstract] [Full Text] [PDF]

				M. Imamura, S. Biro, T. Kihara, S. Yoshifuku, K. Takasaki, Y. Otsuji, S. Minagoe, Y. Toyama, and C. Tei Repeated thermal therapy improves impaired vascular endothelial function in patients with coronary risk factors J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1083 - 1088. [Abstract] [Full Text] [PDF]

				C. Iribarren, A. J. Karter, A. S. Go, A. Ferrara, J. Y. Liu, S. Sidney, and J. V. Selby Glycemic Control and Heart Failure Among Adult Patients With Diabetes Circulation, June 5, 2001; 103(22): 2668 - 2673. [Abstract] [Full Text] [PDF]

				J. A. Beckman, A. B. Goldfine, M. B. Gordon, and M. A. Creager Ascorbate Restores Endothelium-Dependent Vasodilation Impaired by Acute Hyperglycemia in Humans Circulation, March 27, 2001; 103(12): 1618 - 1623. [Abstract] [Full Text] [PDF]

				M. Naghavi, Z. Barlas, S. Siadaty, S. Naguib, M. Madjid, and W. Casscells Association of Influenza Vaccination and Reduced Risk of Recurrent Myocardial Infarction Circulation, December 19, 2000; 102(25): 3039 - 3045. [Abstract] [Full Text] [PDF]

				L. M. Title, P. M. Cummings, K. Giddens, and B. A. Nassar Oral glucose loading acutely attenuates endothelium-dependent vasodilation in healthy adults without diabetes: an effect prevented by vitamins C and E J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2185 - 2191. [Abstract] [Full Text] [PDF]

				H. Tomiyama, Y. Kimura, R. Okazaki, T. Kushiro, M. Abe, Y. Kuwabara, H. Yoshida, S. Kuwata, T. Kinouchi, and N. Doba Close Relationship of Abnormal Glucose Tolerance With Endothelial Dysfunction in Hypertension Hypertension, August 1, 2000; 36(2): 245 - 249. [Abstract] [Full Text] [PDF]

				J. A. Beckman, A. B. Goldfine, M. B. Gordon, L. A. Garrett, and M. A. Creager Inhibition of Protein Kinase C{beta} Prevents Impaired Endothelium-Dependent Vasodilation Caused by Hyperglycemia in Humans Circ. Res., January 11, 2002; 90(1): 107 - 111. [Abstract] [Full Text] [PDF]