THE ARISING · Longevity & Healthspan
Weaker Artery Dilation Tracks With Higher Predicted Heart Risk in Diabetes
Nearly four in five people with type 2 diabetes in a large Chinese hospital group had arteries that did not widen as well as they should, and the weaker the response, the higher their calculated heart risk tended to be.
The finding comes from a retrospective, observational study in Frontiers in Endocrinology, published on 14 October 2026. Researchers analysed records of 1,272 adults with type 2 diabetes managed at the National Metabolic Management Center between March 2020 and March 2025. The patients were seen in the endocrinology department of Zhejiang Provincial People's Hospital. It is a study of people, not a trial. It looks at patterns in existing data and cannot show that one thing causes another.
The test at the centre of the work is called flow-mediated dilation, or FMD. According to the paper, it is a non-invasive marker measured in the brachial artery, in the upper arm. It mainly reflects nitric oxide, a molecule that helps blood vessels relax and widen. The paper describes FMD as a measure of how well the inner lining of the artery, the endothelium, does this job. The authors write that this lining helps regulate vessel tone, limit clotting and manage inflammation.
The researchers defined endothelial dysfunction as an FMD below 6.5%. By that standard, 78.9% of the patients (1,003 of 1,272) had it. The authors say that dysfunction of this kind precedes atherosclerosis, the build-up of fatty deposits in artery walls, in type 2 diabetes. The study did not test why the figure was so high. It reports only that the problem was very common in this group.
The study then compared FMD with each patient's calculated 10-year risk of atherosclerotic cardiovascular disease, or ASCVD. This is a score estimated from patient characteristics, not a count of heart attacks or strokes. Higher FMD was independently linked to lower odds of an intermediate-to-high score (odds ratio 0.90, 95% confidence interval 0.82 to 0.99). The link was modest in strength. As a way to tell higher-risk patients from others, FMD showed moderate ability, with an AUC of 0.700. An AUC of 0.5 is no better than chance and 1.0 is perfect.
The authors also tested whether the relationship bent or flattened at some point. It did not. Their spline analysis found a straight-line, inverse relationship, with no evidence of non-linearity. In plain terms, lower FMD went with higher predicted risk across the range, not only below a cutoff.
The paper also lists factors independently tied to poorer FMD: older age, higher systolic blood pressure (the top number), male sex, smoking and hypertension. Some of these, such as smoking and blood pressure, can change over time. Others, such as age and sex, cannot. The study did not test whether stopping smoking or lowering blood pressure improves FMD or lowers heart risk, so it offers no guidance on that.
The limits are important. The design is retrospective and cross-sectional, so the order of events and cause and effect cannot be established. The outcome is a calculated risk score, not observed heart disease. The patients came from one hospital's programme in China, so the results may not apply elsewhere.
What to watch next
Studies that follow patients over time, to see whether FMD adds information about actual heart attacks and strokes beyond what risk scores already capture.