Hyperglycemia, insulin resistance, sympathetic overdrive, endothelial dysfunction, abnormalities of the angiotensin-renin system (ARS), and LV remodeling/hypertrophy may induce diastolic dysfunction (DD) and impairment of the coronary microcirculation and the microvascular alterations may worsen DD in DM[17]. This evidence concerns the gene REN and endothelial dysfunction.