Cardiovascular Morphological Changes in Metabolic and Endocrine Disorders: A Narrative Review

Metabolic and endocrine disorders profoundly influence cardiovascular morphology through complex mechanisms that converge on endothelial dysfunction. This review synthesises current evidence on structural alterations of the endocardium and arterial system under conditions such as hypertension, diabetes mellitus, metabolic syndrome, and hypothyroidism. Particular attention is given to the endothelium as an active regulator of vascular tone, haemostasis, inflammatory balance, and extracellular matrix dynamics. Chronic metabolic stress, oxidative injury, and dysregulated hormonal signalling drive endothelial-to-mesenchymal transition, smooth muscle cell phenotypic switching, collagen accumulation, and loss of vascular compliance. These processes underlie arterial wall thickening, microvascular rarefaction, endomyocardial fibrosis, and maladaptive myocardial remodelling. Distinct morphological patterns are highlighted across metabolic and endocrine states, including myxedematous changes in hypothyroidism, interstitial fibrosis in diabetes, and hypertrophic vascular remodelling in hypertension. By integrating histological, ultrastructural, and pathogenetic data, this narrative review underscores endothelial dysfunction as a unifying mechanism linking systemic disturbances to cardiovascular pathology. Recognition of these pathways not only advances morphofunctional understanding but also identifies early diagnostic markers and therapeutic targets in cardiometabolic disease.