ELN and diabetes mellitus: While aging is known to cause arterial medial degeneration involving increase in collagen and calcium deposits as well as elastin lamellae fragmentation resulting from upregulation of proteolytic enzymes and possible repetitive cyclic stress on the arterial wall over a life span [34,35], diabetes mellitus has been shown to be associated with the generation of advanced glycation end-products (AGEs) that give raise to collagen crosslinking in the arterial medial layer and contributes to arterial stiffness [33].