Archivum Immunologiae et Therapiae Experimentalis

, Volume 65, Issue 6, pp 463–475 | Cite as

Evaluation of Endothelial Function by Flow-Mediated Dilation: a Comprehensive Review in Rheumatic Disease

  • Luca Moroni
  • Carlo SelmiEmail author
  • Claudio Angelini
  • Pier Luigi Meroni


Flow-mediated dilation (FMD) represents a non-invasive marker of endothelial function to evaluate vascular homeostasis, which reflects the effects of several mechanisms, including vessel tone regulation, cell proliferation, and inflammatory responses. Beyond classical atherosclerotic risk factors such as arterial hypertension, diabetes mellitus, smoking, obesity, and dyslipidemia, chronic inflammation contributes to the endothelial dysfunction causing plaque formation and there is growing evidence of a significantly higher cardiovascular morbidity associated with autoimmune diseases. The endothelium reacts to several endogenous and exogenous stimuli, through surface receptors and intracellular signalling, and releases numerous vasoactive substances, including endothelins, prostacyclins, and nitric oxide (NO). Chronic inflammatory rheumatic diseases are commonly associated with decreased endothelial NO production, vascular damage, and premature atherosclerosis. Despite partially eclipsed by pulse wave velocity measure in the modern scientific literature, we provide a comprehensive overview and critically discuss the available data supporting FMD as a surrogate marker of endothelial function and, therefore, its potential role in predicting early atherosclerosis in patients with rheumatic diseases.


Cardiovascular risk Chronic inflammation Rheumatoid arthritis Psoriatic arthritis Connective tissue disease Autoantibody 



Anti-phospholipid syndrome


Anti-phospholipid antibodies


Cardiovascular disease


Endothelium-derived hyperpolarizing factor


Endothelial NO synthase


Flow-mediated dilation


Mixed connective tissue disease




Nitric oxide


Oxidized low-density lipoproteins


Psoriatic arthritis


Rheumatoid arthritis


Systemic lupus erythematosus




Systemic sclerosis


Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in relation to the presented work.


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Copyright information

© L. Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland 2017

Authors and Affiliations

  • Luca Moroni
    • 1
    • 2
  • Carlo Selmi
    • 3
    • 4
    Email author
  • Claudio Angelini
    • 5
  • Pier Luigi Meroni
    • 4
    • 6
  1. 1.Department of Internal MedicineIRCCS Policlinico San Donato, University of MilanMilanItaly
  2. 2.Systemic Autoimmune Diseases UnitHospital ClìnicBarcelonaSpain
  3. 3.Division of Rheumatology and Clinical ImmunologyHumanitas Clinical and Research CenterMilanItaly
  4. 4.University of MilanMilanItaly
  5. 5.Division of Internal Medicine and NephrologyHumanitas Research HospitalMilanItaly
  6. 6.RheumatologyGaetano Pini HospitalMilanItaly

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