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ROS can also promote the subsequent production of superoxide or hydrogen peroxide from other enzymatic sources that are not normally ROS producers: hydrogen peroxide promotes the uncoupling of endothelial nitric oxide synthase (eNOS) to foster superoxide production rather than nitric oxide production [11, 12] and hydrogen peroxide can convert xanthine oxidoreductase to xanthine oxidase, a superoxide and hydrogen peroxide generator, either by reversible cysteine oxidation or by promoting irreversible proteolysis, [13]
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Endothelial dysfunction, vascular resistance, hypertension, and arterial wall inflammation are more likely to occur in patients with pre-existing microvascular damage, such as that caused by insulin resistance (23)
